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Moderator
Nir Shoham-Hazon, MD
Panelists
Michael S. Berlin, MD, MSc; Robert T Chang, MD, ABO
Viewing Papers
Expand a paper title to the right to view the paper abstract and authors. Use the video link to jump to that poster in the session.
Presenting Author
Gabriel Ayub, MD, PhD
Co-Authors
Vital Costa (MD, PhD)
Purpose
To compare the efficacy and safety of Bent Ab interno Needle Goniotomy (BANG) and Gonioscopy-Assisted Transluminal Trabeculotomy (GATT) in primary open angle glaucoma (POAG) after 24-months.
Methods
Parallel, double-arm, 1:1 ratio, single masked randomized clinical trial. Mild to moderate pseudophakic POAG eyes, defined by visual field mean deviation (MD), with age between 40-80 years and intraocular pressure (IOP)?18mmHg were included. Patients were randomized to BANG or GATT. Follow-up visits were 1, 7, 30, 90, 180, 360, 540 and 720 post-operative days. Primary outcome was mean IOP reduction. Surgical success was defined as IOP?18mmHg and 20% IOP reduction from baseline without the use of medication. Qualified success followed the same parameters, but allowing the use of medication. Longitudinal comparison between the groups was done by a linear mixed model (LMM).
Results
Twenty-two BANG and 23 GATT eyes were included. IOP was 19.87±2.34mmHg at inclusion, 15.62±3.29mmHg at 12-month (p<0.01) and 15.41±4.47mmHg at 24-month (p<0.01) on the GATT group and 21.18±2.87mmHg at inclusion, 16.95±2.82mmHg at 12-month (p<0.01) and 17.79±2.97mmHg at 24-month (p<0.01) on the BANG group (LMM: p=0.05). Medication use was 2.35±0.88 at inclusion, 1.1±1.54 at 12-month (p<0.01) and 0.71±1.1mmHg at 24-month (p<0.01) on the GATT group and 2.41±0.91 at inclusion, 1.82±1.05 at 12-month (p=0.14) and 2.26±1.1 at 24-month (p=0.89) on the BANG group (LMM: p<0.01). GATT had a higher rate of complete (60.9% vs 4.5%, p<0.01) and qualified success (60.9% vs 18.2%, p<0.01) than BANG.
Conclusion
At 24-months, GATT presented lower mean IOP and medication use, and higher surgical success than BANG.
Presenting Author
Justin Spaulding, DO
Purpose
To evaluate the efficacy and safety of ab-interno canaloplasty (ABiC) combined with microstent implantation in patients with severe glaucoma.
Methods
This retrospective study included patients with severe glaucoma (mean age 74.6±8.7 years), predominantly primary open-angle (90%). All eyes underwent combined ab-interno canaloplasty using the iTrack (Nova Eye Medical) with concurrent Hydrus Microstent (Alcon) implantation during cataract surgery. The primary outcome measures were intraocular pressure (IOP), number of glaucoma medications, visual field mean deviation (VFMD), postoperative complications.
Results
69 eyes of 56 patients were followed for mean 27.9±13.8 months. Mean IOP decreased from 17.8±6.3 at preop to 15.5±4.7 mmHg at last follow-up (LFU) (p=0.012). Mean meds (no.) decreased from 2.10±1.1 to 1.12±1.2 (p<0.001). VFMD remained stable (p=0.466). Med-free eyes increased from 7% at preop to 43% at LFU. Among eyes that were on 3 and 4 meds preoperatively (n=17; n=7), meds use significantly decreased by 53% (p<0.001) and 57% (p=0.002) at LFU, while IOP remained stable. Eyes with baseline IOP >18 mmHg (n=21) experienced a significant mean IOP reduction of 9.8 mmHg (−40%, p<0.001). No complications were reported; 6 eyes (9%) required additional glaucoma procedures during follow-up.
Conclusion
ABiC combined with Hydrus Microstent implantation during cataract surgery significantly lowered IOP and reduced meds with favorable safety profile. Findings suggest dual-mechanism MIGS approach may extend the role of minimally invasive procedures for patients with severe glaucoma traditionally managed with filtering surgery.
Presenting Author
Arkadiy Yadgarov, MD
Purpose
To evaluate 12-month safety and effectiveness of standalone iStent infinite implantation in eyes with open-angle glaucoma (OAG) refractory to or already on maximally tolerated medical therapy.
Methods
This retrospective, single-center case series included 51 OAG eyes with predominantly moderate-to-advanced OAG undergoing standalone iStent infinite placement without preoperative medication washout. The primary analysis included 42 eyes that completed 12 months of follow-up without additional glaucoma procedures. Nine eyes were excluded from the analysis due to requiring either secondary surgical intervention or selective laser trabeculoplasty (SLT) within 12 months. Intraocular pressure (IOP) and topical IOP-lowering medication use were compared from baseline to month 12 (M12). Safety outcomes were also assessed.
Results
In the analysis cohort (n=42), mean IOP decreased from 19.3 ± 4.5 mmHg to 15.4 ± 2.9 mmHg at M12 (20.4% reduction; P<0.001). Mean med use remained stable (2.1 ± 1.3 vs 1.9 ± 1.1; P=0.50). 81.0% (34/42) of eyes were on the same or fewer meds: those on unchanged meds achieved a 25.0% IOP reduction, while eyes on fewer meds achieved a 12.6% reduction. No adverse events were reported.
Conclusion
Standalone iStent infinite achieved significant, sustained IOP reductions at 12 months, with stable or reduced med use in most eyes and no adverse events. Nine eyes required additional glaucoma procedures, but the overall safety and efficacy support its role as a valuable standalone glaucoma option.
Presenting Author
Nimrita Nagdev, MS, MBBS
Co-Authors
Devendra Maheshwari (MD), Madhavi Pillai (DNB, MBBS)
Purpose
To compare the safety and efficacy of gonioscopy-assisted transluminal trabeculotomy (GATT) versus Kahook dual blade (KDB) with phacoemulsification in eyes with primary open-angle glaucoma.
Methods
A retrospective and comparative study included 122 eyes (61 GATT, group 1, and 61 KDB, group 2). Baseline characteristics like intraocular pressure (IOP), best corrected visual acuity (BCVA), and anti-glaucoma medications (AGMs) were compared at each postoperative visit. Data were collected at 2 weeks and 1, 3, 6, and 12 months. Surgical success was defined as IOP ?21 /?18 /?15 mmHg with> 20%/25%/30% reduction from baseline, respectively (Criteria 1,2 and 3). Complications, secondary interventions, and surgical risk factors were also analyzed.
Results
The mean (SD) IOP decreased from 21.15±3.76 to 13.20±3.21 and from 22.90±4.05 to 14.44±5.01 in groups 1 and 2, respectively, at the end of 12 months (p<0.001). AGM reduced from 1.64±0.84 to 0.08±0.28 and from 1.67±0.77 to 0.08±0.38 in groups 1 and 2, respectively, at the end of 12 months (p<0.001). The overall success was 85.3%, 78.7%, and 60.7% in group 1 by criteria 1, 2, and 3. In group 2, it was 86.9%, 83.6%, and 70.5%. Micro hyphemas were seen in 28 patients (20 (group 1), 8 (group 2)), and macro hyphemas were seen in 4 patients of group 1. 6 had IOP spikes (4 in group 1, 2 in group 2). AC wash was done in 2 patients.
Conclusion
Both GATT and KDB achieved significant reductions in intraocular pressure and anti-glaucoma medication use at 12 months, with KDB demonstrating safety and efficacy equivalent to 360° suture trabeculotomy.
Presenting Author
Yazan Abubaker, MD
Co-Authors
Abhimanyu Ahuja (MD), Syril Dorairaj (MD), Bryan C. H. Ang (MBBS, FRCOphth), Raphael Banoub (MD, BSc), Kelvin Shi (BSc)
Purpose
To evaluate the initial safety and efficacy of canaloplasty using the VIA360 device (New World Medical, Rancho Cucamonga, CA, USA) in eyes with open-angle glaucoma.
Methods
A retrospective chart review study included 41 eyes from 26 patients with open-angle glaucoma that underwent canaloplasty using the VIA360 device. Baseline data included intraocular pressure (IOP), number of glaucoma medications, and best-corrected visual acuity (BCVA, LogMAR). Postoperative (post-op) outcomes were collected through the last available follow-up, including IOP, glaucoma medication burden, BCVA, and adverse events. Paired t-tests were used to compare baseline and last follow-up values.
Results
Mean age at surgery was 71.3 ± 9.3 years. At baseline, mean IOP was 18.7 ± 5.9 mmHg on 1.4 ± 1.2 glaucoma medications, and mean BCVA was 0.30 ± 0.41 LogMAR. At 6 months, the mean IOP decreased to 13.5 ± 5.6 mmHg (p < 0.001 vs. baseline), with a reduction in glaucoma medication to 0.85 ± 1.26 (p < 0.001 vs. baseline). A total of 25 eyes (61%) were medication-free at the last follow-up. BCVA remained stable (0.29 ± 0.49 LogMAR, p = 0.84). Hyphema occurred in 5 eyes, with a mean duration of 1.8 ± 2.7 days, all resolving within the first post-op week. Transient IOP spikes consistent with steroid response were observed in 3 eyes between 2-6 weeks post-op and resolved with steroid tapering.
Conclusion
Our results on canaloplasty using the VIA360 device demonstrated a favorable initial safety profile and was effective in reducing IOP and medication burden in eyes with open-angle glaucoma.
Presenting Author
Devendra Maheshwari, MD
Co-Authors
Madhavi Pillai (DNB, MBBS), Nimrita Nagdev (MS, MBBS)
Purpose
Comparison of outcomes of trabeculotomy-based MIGS procedures Gonioscopy-assisted transluminal trabeculotomy (GATT),Kahook Dual Blade (KDB) goniotomy, Interventional valve enhancing trabeculotomy (iVent), Bent Ab-interno Needle Goniectomy (BANG), and Tanito microhook trabeculotomy (TMH) combined with phacoemulsification in open-angle glaucoma.
Methods
This prospective study included 234 eyes undergoing GATT (n=53), KDB (n=51), iVEnT (n=52), BANG (n=34), or TMH(n=44).All the MIGS procedures were combined with phacoemulsification. Baseline characteristics like Intraocular pressure (IOP), Best corrected visual acuity (BCVA), and anti-glaucoma medications (AGMs) were compared at each post-operative visit. Data were collected at 2 weeks, 1 month, 3,6, and 12 months. Surgical success was defined as IOP ?21 /?18 mmHg with> 20%/25%reduction from baseline, respectively (Criteria 1, 2 ). Complications, secondary interventions, and surgical risk factors were also analyzed
Results
Mean(SD)IOP(mmHg) reduced from 21.58±4.69 to 12.83±3.01 at end of 1 yr in GATT grp,with reduction in AGM from 1.55± 0.75 to 0.15±0.46.In the KDB grp(22.33±2.69mmHg to 14.51±5.04 mmHg;1.63±0.75 to 0.08±0.39 AGMs),iVEnT grp(20.85±3.38mmHg to 13.73±2.88mmHg;1.75±0.93 to 0.04±0.19 AGMs),BANG grp (22.18±2.46 mmHg to 15.42±4.38mmHg;1.50±0.71 to 0.29±0.64),TMH grp(22.48±3.79 mmHg to 14.48±4.13 mmHg ;1.43±0.66 to 0.26±0.63 AGMs).GATT-Phaco group had the maximum IOP % reduction of 38.7%,followed by KDB,TMH&iVEnT(34.1%,34.5%,33.1%)&least with BANG(30.2%).Complete success-criteria 1 &2 were more in GATT(89.1%,79.3%)&KDB (86.3%,82.4%),followed by iVEnT(76.9%,69.2%),BANG(79.4%,79.4%)&TMH(75%,72.7%).
Conclusion
At the end of 12 months,GATT and KDB combined with phacoemulsification demonstrated similar and most favorable outcomes,followed by Tanito,iVEnT,BANG in open-angle glaucoma. All approaches significantly lowered IOP and AGM,reinforcing MIGS as a safe&valuable strategy in glaucoma.
Presenting Author
Devendra Maheshwari, MD
Co-Authors
Nimrita Nagdev (MS, MBBS), Madhavi Pillai (DNB, MBBS)
Purpose
To compare the surgical outcomes of Interventional valve enhancing trabeculotomy(iVEnT) combined with phacoemulsification versus standalone phacoemulsification in open angle glaucoma
Methods
Design - Prospective , comparative ,interventional study.A novel surgical technique of Interventional valve enhancing trabeculotomy(iVEnT)takes advantage of the motion dependent outflow.It utilises a unique spatula to create a tiny vent in the anterior non -filtering part of TM.The key benefit is the unharmed trabecular meshwork and minimal damage to the intracanalicular valve system. 106eyes(53Phaco-Group 1,53 iVEnT-phaco -Group 2)were included & followed for 2 wks,1,3,6&12 months.Outcome measures were IOP,AGM,BCVA surgical success, complications.Surgical success was defined as IOP ?21/?18/?15 with >20%, 25%,30% reduction(Criteria 1,2,3)
Results
Mean IOP decreased from 24.0±6.1 to 16.4± 3.7,18.04±3.7,18.7±3.6mmHg with 19.1% reduction in Group1 and from 21.28 ±4.2 to13.2±3.2,13.8 ±3.2,13.7±2.8 mmHg with 33.8% reduction in Group 2 at 3,6,12months,with significant difference between the groups(p<0.001).AGM changed from 1.35±0.5 to 1.55 ±0.7(p=.010)in Group 1 and 1.7± 0.9 to 0.04±0.19 in Group 2(p<0.001).Cumulative probability of overall success in Group 1 was 60.4%,41.5%,17.9% and Group2 77.4%,69.8%,54.7% (p=0.045,0.002,<0.001) by Criteria1,2,3.IOP spikes were seen in 4 patients in Group 1 and 2 patients in Group 2.Two patients in Group 2 had microhyphema which resolved with conservative management without interventions.
Conclusion
iVEnT with Phacoemulsification is safe and efficacious in Open angle glaucoma. IVEnT adds a unique and novel TM sparing procedure to the MIGS armamentarium
Presenting Author
Nimrita Nagdev, MS, MBBS
Co-Authors
Devendra Maheshwari (MD), Madhavi Pillai (DNB, MBBS)
Purpose
To compare the safety and efficacy of gonioscopy-assisted transluminal trabeculotomy in open-angle glaucoma associated with high myopia.
Methods
A prospective, interventional, and comparative study included 36 high myopia (group 1) and 40 non-high myopia (group 2) patients with open-angle glaucoma. Combined gonioscopy-assisted transluminal trabeculotomy with phacoemulsification was performed in both groups. Baseline characteristics like intraocular pressure (IOP), best corrected visual acuity (BCVA), and anti-glaucoma medications (AGMs) were compared. Data were collected at 2 weeks and 1, 3, 6, and 12 months. Surgical success was defined as IOP ?21/?18/?15 mmHg with >20%/25%/30% reduction from baseline, respectively (Criteria 1, 2, and 3). Complications, secondary interventions, and surgical risk factors were also analyzed.
Results
The mean (SD) IOP (mmHg) decreased from 20.56±4.71 to 13.32±5.02and from 19.33±4.15 to 12.94±3.48 in groups 1 and 2, respectively, at the end of 12 months (p<0.001). AGM reduced from 2.11±0.89 to 0.36±0.95 and 1.63±0.87to 0.06±0.24 in groups 1 and 2, respectively, at 12 months (p<0.001). Success rate was 84.0%, 69.3%, and 43.5% by criteria 1, 2, and 3, respectively, in group 1. In group 2, it was 87.5%, 74.3%, and 61.3%. Micro hyphemas were seen in 18 patients (8 in group 1, 10 in group 2), and macro hyphemas were in 7 patients (3 in group 1, 4 in group 2). 11 had IOP spikes (6 in group 1, 5 in group 2). AC was done in 4 patients (2 in each group).
Conclusion
Combined gonioscopy-assisted transluminal trabeculotomy with phacoemulsification is a safe and effective procedure in open-angle glaucoma associated with high myopia. It showed similar outcomes in terms of IOP and AGM reduction to the control group at 12 months.
Presenting Author
Nimrita Nagdev, MS, MBBS
Co-Authors
Devendra Maheshwari (MD), Madhavi Pillai (DNB, MBBS)
Purpose
To compare the safety and efficacy of gonioscopy-assisted transluminal trabeculotomy in primary open-angle glaucoma and pseudo-exfoliation glaucoma.
Methods
Prospective, interventional and comparative study included 74 primary open-angle glaucoma (group 1) and 76 pseudo-exfoliation glaucoma (group 2) patients. Combined gonioscopy assisted transluminal trabeculotomy with phacoemulsification was performed in both groups. Baseline characteristics like intraocular pressure (IOP), best corrected visual acuity (BCVA), and anti-glaucoma medications (AGMs) were compared. Data were collected at 2 weeks, 1 month, 3, 6, 12, and 24 months. Surgical success was defined as IOP ?21/?18/?15 mmHg with >20%/25%/30% reduction from baseline, respectively (Criteria 1,2 and 3). Complications, secondary interventions, and surgical risk factors were also analyzed.
Results
The mean (SD) IOP (mmHg) decreased from 21.26±3.69 to 14.09±3.42 and from 27.46±6.57 to 13.17±2.57 in groups 1 and 2, respectively, at the end of 24 months. (p=0.117). AGM reduced from 1.69±0.84 to 0.38±0.57 and 1.88±0.75 to 0.11±0.44 in groups 1 and 2, respectively, at 24 months (p = 0.002). Success rates were 85.1%, 76.8%, and 58% by criteria 1, 2, and 3 in group 1, respectively. In group 2, it was 98.6%, 95.8%, and 87.6%. Micro hyphemas were seen in 34 patients (20 in group 1, 14 in group 2), macro hyphemas in 10 patients (6 in group 1, 4 in group 2), and 19 patients had IOP spikes (8 in group 1, 11 in group 2). 6 patients required AC wash (4 in group 1, 2 in group 2).
Conclusion
Gonioscopy-assisted transluminal trabeculotomy significantly reduced intraocular pressure and medication burden in primary open-angle glaucoma and pseudo-exfoliation glaucoma, with better success in the later group at 24 months.
Presenting Author
Saige M. Oechsli, BSc
Co-Authors
Havish Gadde (BSc), Avigyan Sinha (MSE), Abhishek Rege (PhD), Osamah Saeedi (MD, MS)
Purpose
Success of minimally invasive glaucoma surgeries (MIGS) is challenging to assess intraoperatively, which may contribute to inconsistent clinical outcomes. Quantifying episcleral venous flow (EVF) pre and post MIGS could improve these interventions. We aim to develop a novel method for intraoperatively evaluating MIGS efficacy in an animal model.
Methods
Noninvasive laser speckle contrast imaging (LSCI) and indocyanine green episcleral angiography was conducted on 12 eyes of 7 male New Zealand white rabbits. LSCI videos were captured at baseline intraocular pressure (IOP) and syringe pump-modulated IOPs, 25-55 mmHg. A 25-gauge needle was used to perform a 3-clock hour goniotomy before imaging again at modulated IOPs. Images were registered and regions of interest (ROI) capturing superior episcleral vessels extending 6 mm from the limbus were chosen for each eye. Mean blood flow value indices (BFVi) for the entire ROI were extracted. Repeatability was assessed at each IOP. A paired t-test was used to determine the significance of EVF changes.
Results
Overall, mean BFVi increased at all IOPs postoperatively (p<0.05), with an average percent change in EVF of 22.6±35.2%. The change in EVF ranged from 12.2±22.7% at 55 mmHg to 27.1±52.1% at 45 mmHg. The intrasession variability of measured EVF within each IOP was approximately 3.02±2.86%. 10 out of 12 eyes had statistically significant increases in BFVi in the selected ROI.
Conclusion
LSCI presents a noninvasive, reproducible, novel method of quantifying episcleral flow pre and post goniotomy intraoperatively. Increase in episcleral flow after goniotomy as measured by LSCI shows promise in assessing MIGS efficacy. This could offer physicians immediate feedback on surgical success, ultimately improving clinical outcomes.
Presenting Author
Ana IM Miguel, PhD
Co-Authors
Elise Baron (MD), Aur�lie Genecque (None)
Purpose
To assess the long-term safety and efficacy of the Gel Stent in a real-world population.
Methods
We performed a single-center retrospective study that included all patients who received a gel stent between September 2018 and October 2023. The primary outcome was complete surgical success (defined as ?20% decrease in intraocular pressure, IOP, without medication nor serious complications nor vision loss) at 2 years, and at 5 years. Secondary endpoints included: qualified surgical success (?20% decrease in IOP but with IOP-lowering agents) at 2 years and 5 years, number of postoperative IOP-lowering classes, failure, IOP, complications, needlings, visual acuity, retinal nerve fiber layer thickness (RNFL), and mean deviation in the visual field. Needlings were not considered as failures.
Results
101 eyes of 83 patients were included (41 standalone, 60 combined with cataract surgery) in our study. The complete surgical success was of 33.3% at 5 years, and mean IOP from 17.98mmHg to 13.68mmHg at 5 years, with a mean reduction of 22%±4,98. IOP-lowering agents decreased significantly at all times, from 3±0,99 (IC95% 0.87-1.15) classes before surgery to 1± 1,33 (IC95% 1.0-1.99) at 5 years. Needling was needed in 38.9% of cases. Among the 22 failures, ten eyes required trabeculectomy to control IOP, and one case of endophthalmitis was noted.
Conclusion
45µm Gel Stent, alone or in combination, provides effective, long-lasting IOP and medication reduction up to 5 years, with an acceptable safety profile. Nevertheless, needling is often necessary, and efficacy seems to decrease over time, as with any filtering surgery.
Presenting Author
Mohideen A Kader, DNB
Co-Authors
Madhavi Pillai (DNB, MBBS), Rengappa Ramakrishnan (MS)
Purpose
To compare the surgical outcomes and safety of 5-0 prolene Gonioscopy assisted transluminal trabeculotomy(GATT) versus Trabeculectomy combined with phacoemulsification in PACG
Methods
Prospective, Comparative, Interventional. 90 eyes Phaco-GATT(N=45) and Phaco-Trab(N=45) were included,Follow up period - 12 months.Outcome measures-intraocular pressure (IOP), percentage IOP reduction, antiglaucoma medications (AGM), patients remaining AGM-free, and best-corrected visual acuity (BCVA).Success was defined as at least 20%/25%/30% IOP reduction and IOP <21, 18, or 15 mmHg(Criteria 1, 2, or 3)
Results
The mean IOP % reduction was significantly higher in the Phaco-GATT group. (43.8 vs 36%,p=0.045).Surgical success was significantly higher in the PhacoGATT group by criteria 1 and 3(p=0.041,p=0.013). The Cox proportional hazard model showed that patients undergoing Phaco-Trab have a higher risk of surgical failure compared to those undergoing Phaco-GATT by criteria 3 in both univariate (HR = 5.40, 95% CI [1.18 to 24.66])(p=0.030) and multivariable analysis (HR = 5.17, 95% CI [1.03 to 25.90](p=0.046).Two patients in Phaco-GATT -Anterior chamber wash, 2 patients inPhaco-Trab group underwent bleb needling, one patient-Choroidal detachment and one patient underwent transconjunctival suturing.
Conclusion
Phaco-GATT is safe, efficacious, and superior to Phaco-Trabeculectomy in primary angle closure glaucoma.
Presenting Author
Marc Toeteberg-Harms, MD
Co-Authors
John Liu (JD)
Purpose
This systematic review and meta-analysis aimed to evaluate the long-term efficacy and safety of excimer laser trabeculostomy (ELT) as a standalone procedure or combined with phacoemulsification (Phaco-ELT) in the treatment of patients with glaucoma.
Methods
ELT is an implant-free, ab-interno, minimally-invasive glaucoma surgery that creates microchannels in the trabecular meshwork, facilitating aqueous outflow while preserving angle anatomy. It can be performed as a standalone procedure or combined with phaco. A systematic literature review was conducted by two independent reviewers using PubMed and EMBASE databases to identify articles that examined efficacy and safety endpoints of ELT or Phaco-ELT procedures in adult patients with glaucoma. Endpoints included absolute reduction in glaucoma medication, intraocular pressure (IOP), and visual acuity at 1 and 2 years follow-up. A total of 14 eligible articles (N=1549 eyes) were identified.
Results
At Year 2, the IOP reduction achieved with ELT and Phaco-ELT was 7.10 mmHg (95%CI:6.25, 7.95; n=105) and 6.72 mmHg (95%CI: 3.01, 10.42; n=130), respectively. Absolute glaucoma medications were reduced by 1.26 (95%CI: 0.74, 1.78; n=95) and 0.58 (95%CI: 0.33, 0.83; n=130), respectively. In patients undergoing phaco-ELT, visual acuity improved by -0.12 LogMAR (95% CI: -0.20, -0.05; n=70). After 1 year, the total complication rate with ELT and Phaco-ELT was 2.67% (95% CI: 1.00, 6.89; n=150) and 4.09% (95% CI: 1.96, 8.34; n=171), respectively, and the rate of additional surgeries was 30.82% (95% CI: 24.14, 38.41; n=159) and 5.55%, respectively.
Conclusion
This analysis found that ELT reduced IOP and IOP-lowering medication burden in patients with glaucoma, with minimal occurrence of complications and a low rate of secondary interventions. When combined with phaco, ELT results in a simultaneous improvement in visual acuity.
Presenting Author
Inder P. Singh, MD
Purpose
To evaluate clinical outcomes of a microinvasive glaucoma surgery (MIGS) procedure, excimer laser trabeculostomy (ELT) plus cataract surgery in primary-open angle glaucoma (POAG) patients.
Methods
Between January 2024 and June 2024, patients with POAG received ELT in combination with cataract surgery at a single site in Panama. The MIGS procedure was conducted by ELIOS device (Bausch + Lomb) which uses a 308nm XeCL excimer laser to create ten 210µm microchannels in the trabecular meshwork to facilitate aqueous outflow. Retrospectively reviewed data included intraocular pressure (IOP), number of topical IOP-lowering medications, corrected distance visual acuity (CDVA) and adverse events (AEs), pre- and 1-month post-surgery,
Results
Procedures were performed in 12 patients (6 bilateral, 6 unilateral, N=18 eyes). Mean±SD age was 69±3 years; with 58% female. Preoperative mean±SD IOP was 20.0 ± 1.0mmHg, mean IOP-lowering medications was 0.5 ± 0.2, and mean CDVA was 1.2±0.1logMAR. At 1-mo follow up, postoperative mean±SD IOP was 15.0±1.1mmHg, with 0.3±0.1 of IOP-lowering medications, and CDVA of 0.3±0.1logMAR. No intra- or post-operative interventions or AEs were reported.
Conclusion
The ELIOS procedure in combination with cataract surgery lowered mean IOP below the targets for early and moderate glaucoma (<20 mmHg and < 17 mmHg) in POAG patients without secondary surgical interventions or AEs.
