Excimer Laser Trabeculostomy (ELT): An Effective MIGS Procedure for Open-Angle Glaucoma

Berlin, Michael S.; Töteberg‐Harms, Marc; Kim, Edward; Vuong, Iris; Giers, U.

doi:10.1007/978-1-4614-8348-9_8

Cited by 4 publications

(13 citation statements)

References 27 publications

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“…Despite this discrepancy in the depth of treatment, much like the present report regarding FLT, ELT does not cause thermal collateral damage to the surrounding tissues. Berlin et al 17 reported the patency of clear holes into the Schlemm's canal at 2.5 years after ELT. This indicates little to no wound healing response or scar tissue formation, likely because of the lack of thermal collateral damage.…”

Section: Discussionmentioning

confidence: 99%

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Femtosecond Laser Trabeculotomy in Perfused Human Cadaver Anterior Segments: A Novel, Noninvasive Approach to Glaucoma Treatment

Mikula

Ráksi

Ahmed

et al. 2022

Trans. Vis. Sci. Tech.

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Purpose The purpose of this study was to investigate femtosecond laser trabeculotomy (FLT) in a clinically relevant manner (i.e., delivering the surgical laser beam through the cornea of the intact, human anterior segment to create channels from the anterior chamber into the Schlemm's canal) and to investigate the effect of this treatment on intraocular pressure in perfused human anterior segments. Methods Perfused human anterior segments (15 eyes) received either FLT treatment (n = 8) or a sham-treatment (n = 7). Intraocular pressure (IOP) in the perfused samples was recorded before and after treatment. Spectral domain optical coherence tomography, second harmonic generation imaging, and transmission electron microscopy were used to investigate the FLT channels. Results The FLT group (n = 7, 1 eye excluded) had a statistically significant reduction in mean IOP of 20.2% from baseline after treatment (5.06 ± 1.46 mm Hg to 4.04 ± 1.63 mm Hg; P < 0.0005), whereas the control group (n = 7) remained statistically unchanged (7.72 ± 3.45 mm Hg to 7.78 ± 3.51 mm Hg; P < 0.71). Imaging confirmed that the channels traversed the entire trabecular meshwork into the Schlemm's canal. Conclusions This study has provided the first direct evidence supporting the feasibility of clinically applicable, noninvasive femtosecond laser trabeculotomy for the treatment of glaucoma. Various imaging modalities revealed minimal collateral damage to adjacent issues. Translational Relevance This work demonstrates noninvasive femtosecond laser trabeculotomy in a laboratory setting that is clinically relevant.

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Section: Discussionmentioning

confidence: 99%

“…Published data report the longevity of this procedure and patency of the holes out to at least two years, although the eye must still be opened to introduce the laser. 16 , 17 …”

Section: Introductionmentioning

confidence: 99%

Femtosecond Laser Trabeculotomy in Perfused Human Cadaver Anterior Segments: A Novel, Noninvasive Approach to Glaucoma Treatment

Mikula

Ráksi

Ahmed

et al. 2022

Trans. Vis. Sci. Tech.

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“…The ELT procedure evolved from these full-thickness fistula procedures to create ab interno channels that end within Schlemm’s canal, e.g., trabeculostomy, due to the precision of excimer laser/tissue interactions in which tissue excision depth could be precisely calculated [ 35 ]. These laser/tissue interactions are remarkably dissimilar to those of the frequency-doubled Nd:YAG laser (532 nm) used for SLT.…”

Section: Excimer Laser Trabeculostomy (Elt)mentioning

confidence: 99%

“…While the 193 nm excimer laser is ideal for corneal surface ablation, this wavelength is not fiber-optically transmissible. Thus, the 308 nm excimer laser, which is fiber-optically transmissible, enables intracameral procedures [ 35 ]. This approach to bypass outflow obstruction is similar to stent-based MIGS but does not require foreign body implants, e.g., stents.…”

Section: Excimer Laser Trabeculostomy (Elt)mentioning

confidence: 99%

“…ELT (earlier known as excimer laser trabeculotomy) utilizes a 308 nm xenon chloride excimer laser to precisely create channels between the anterior chamber and Schlemm’s canal to increase outflow channels and lower IOP for open-angle glaucoma. The ab interno, non-thermal approach protects the integrity of adjacent tissues and collector channels with minimal scar formation and inflammatory responses [ 35 , 38 ]. Additionally, since ELT uses a laser, there are no foreign bodies or devices implanted, lowering further risks of complications.…”

Section: Excimer Laser Trabeculostomy (Elt)mentioning

confidence: 99%

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Advances in Excimer Laser Trabeculostomy within the Landscape of Minimally-Invasive Glaucoma Surgery

Nguyen

Simon

Doan

et al. 2022

JCM

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Primary open-angle glaucoma (POAG) is currently treated with a variety of surgical and non-surgical approaches. Minimally invasive glaucoma surgery (MIGS) involves several devices and procedures that lower intraocular pressure (IOP) by increasing aqueous outflow. The first laser-based MIGS procedure, Excimer Laser Trabeculostomy (ELT), has emerged as a safe and effective treatment option. This article reviews ELT within the context of alternative MIGS procedures and focuses on the historical development of ELT, principles and techniques of the ELT procedure, safety and efficacy data, comparison to other outflow procedures, and future augmentations to expand the use of ELT. Performed alone or as an adjunct to cataract surgery, ELT has minimal complications and has shown long-term effectiveness in lowering intraocular pressure in thousands of patients. The non-thermal laser-tissue interactions of excimer lasers minimize peripheral tissue damage and ensure outflow channel patency without requiring foreign body implants or creating blebs. The development of 2D optical and 3D optical coherence tomography (OCT) guidance systems will eliminate the need for a goniolens to visualize angle structures and enable thousands more surgeons to perform ELT in the future.

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Eight-year follow-up of excimer laser trabeculostomy alone and combined with phacoemulsification in patients with open-angle glaucoma

Berlin

Shakibkhou

Tilakaratna

et al. 2022

J Cataract Refract Surg

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To describe the 8-year results of excimer laser trabeculostomy (ELT) alone and ELT in conjunction with phacoemulsification (phaco).Setting: University hospital.Design: Retrospective review.Methods: 308 nm excimer laser energy delivered through an intraocular fiber-optic probe created channels through the inner wall of Schlemm canal. 2 groups were studied: ELT alone and ELT + phaco. Inclusion criteria were adult patients with open-angle glaucoma or ocular hypertension on 1 or more intraocular pressure (IOP)lowering medications and, in the ELT + phaco group, presence of visually significant cataract. Primary outcome measures were change of IOP from baseline and number of IOP-lowering medications.Results: 164 eyes in 2 groups, ELT alone (n = 90) and ELT + phaco (n = 74), were followed up for 8 years. Baseline IOP was 22.17 ± 7.0 mm Hg and 21.9 ± 6.44 mm Hg in the ELT alone and the ELT + phaco groups, respectively. IOP in the ELT alone group decreased to 16.84 ± 5.2 mm Hg at 1 year (n = 69) and remained at 15.9 ± 3.5 (n = 19) at 8 years. IOP in the ELT + phaco group was 14.04 ± 4.1 mm Hg at 1 year (n = 63) and 13.7 ± 2.8 mm Hg at 8 years (n = 13). The number of IOP-lowering medications at baseline in the ELT alone group was 1.85 ± 0.8 and decreased to 1.19 ± 1.10 at 1 year and 1.4 ± 1.4 at 8 years. In the ELT + phaco group, it was 1.58 ± 0.8 at baseline and decreased to 0.97 ± 0.95 at 1 year and 1.85 ± 0.7 at 8 years.Conclusions: ELT demonstrated long-term IOP lowering and decrease in the number of IOP-lowering medications. Benefits of this laser-based implant-free microinvasive glaucoma surgery procedure included a high safety profile and long-term efficacy.

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Excimer Laser Trabeculostomy (ELT): An Effective MIGS Procedure for Open-Angle Glaucoma

Cited by 4 publications

References 27 publications

Femtosecond Laser Trabeculotomy in Perfused Human Cadaver Anterior Segments: A Novel, Noninvasive Approach to Glaucoma Treatment

Femtosecond Laser Trabeculotomy in Perfused Human Cadaver Anterior Segments: A Novel, Noninvasive Approach to Glaucoma Treatment

Advances in Excimer Laser Trabeculostomy within the Landscape of Minimally-Invasive Glaucoma Surgery

Eight-year follow-up of excimer laser trabeculostomy alone and combined with phacoemulsification in patients with open-angle glaucoma

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