Abstract
Purpose: :
Excimer Laser Trabeculostomy (ELT) is a novel surgical treatment for open angle glaucoma in which openings are created ab interno through the trabecular meshwork into Schlemm’s canal.
Methods: :
Ab interno trabeculostomy (ELT) was performed using a 308 nm excimer laser on 166 eyes of 166 patients with primary open-angle glaucoma or secondary glaucoma aged 70±13 years. All surgical procedures were performed by a single surgeon .308 nm excimer laser energy is delivered by a 200-µm fiber in a 500-µm probe crossing the anterior chamber via a superior temporal limbal paracentesis which contacts the infero-nasal trabecular meshwork to create 10 openings by non-thermal photoablation. Intra-ocular pressure (IOP) was measured pre-op and at: 1 week (160 eyes), 1 month (151 eyes), 3 months (142 eyes), and 1 year (130 eyes).
Results: :
Pre-operative intra-ocular pressure (IOP) of 26.4 (±6.2) mmHg; was reduced after 1 week to 19.1 (±8.7); after 1 month to 18.8 (±6.2); after 3 months to 18.2 (±5.8); and after 1 year to 16.9 (±4.7). The pressure reduction was statistically significant at all time points (variance analysis, Bonferroni correction, alpha: p<0.00001). The average number of anti-glaucoma medications was the same (1.5±1.2) both before and after ELT surgery.
Conclusions: :
Excimer Laser Trabeculostomy appears to be safe and effective in lowering IOP for at least one year in primary open-angle and secondary glaucoma. The intra- and post-operative complications are significantly less than in trabeculectomy. In addition, ELT does not interfere with the subsequent performance of any other pressure-lowering surgical procedures if necessary. No additional procedures were needed in any patients in this cohort.
Keywords: laser • trabecular meshwork • intraocular pressure