A meta-analysis focused on excimer laser trabeculostomy alone and combined with phaco.

Excimer laser trabeculostomy reduced both IOP and medication burden in patients with open-angle glaucoma or ocular hypertension, according to a poster at the American Glaucoma Society meeting.

"ELT can be performed as a stand-alone trabecular MIGS procedure or combined with phacoemulsification cataract extraction," Marc Toeteberg-Harms, MD, FEBO, of the University of Iowa, told Healio. "As long as the ongoing FDA trials (in combination with phaco and stand-alone) are not published, the authors wanted to review the existing evidence for stand-alone and combination ELT with 1 and 2 years of follow-up."

Toeteberg-Harms and colleagues performed a systemic literature review and meta-analysis of 14 articles in PubMed and Embase to investigate the long-term efficacy and safety of stand-alone excimer laser trabeculostomy (ELT) and combined phaco-ELT in 1,549 eyes.

The mean absolute reduction in IOP at 2 years was 7.1 mm Hg for stand-alone ELT (95% CI, 6.25-7.95) and 6.72 mm Hg (95% CI, 3.01-10.42) for phaco-ELT. For medication burden, ELT yielded a mean absolute reduction of 1.26 glaucoma medications (95% CI, 0.74-1.78) and phaco-ELT yielded a mean absolute reduction of 0.58 glaucoma medications (95% CI, 0.33-0.83).

The mean absolute reduction in visual acuity in both groups at 2 years was -0.12 (95% CI, -0.2 to -0.05), according to the poster. At 1 year, the total complications rate was 2.67% (95% CI, 1%-6.89%) for ELT and 4.09% (95% CI, 1.96%-8.34%) for phaco-ELT, demonstrating a favorable safety profile, while the rate for additional surgeries needed was 30.82% (95% CI, 24.14%-38.41%) for ELT and 5.55% (95% CI, 2.45%-12.09%) for phaco-ELT. The most common complication was self-resolving mild hyphema, Toeteberg-Harms told Healio.

"ELT is a safe and effective procedure that lowers both IOP and medication burden," he said. "It has proven effectiveness in the treatment of ocular hypertension and mild to moderate OAG."