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

• Authors: Anne Nguyen, Charles R. Drew University of Medicine & Science; Brian Simon, Loyola University Chicago; Rebecca Doan, Glaucoma Institute of Beverly Hills; Emily Chen, Emory University; Ryan Lamrani, Glaucoma Institute of Beverly Hills; Jonathan Shakibkhou, Glaucoma Institute of Beverly Hills; Michael S Berlin, Glaucoma Institute of Beverly Hills
• Journal Title: JOURNAL OF CLINICAL MEDICINE
• Volume: Volume 11, Number 12
• Publisher: MDPI | 2022-06-01
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.3390/jcm11123492
• Subjects: Health Sciences, Medicine and Surgery
• Keywords: Science & Technology; Life Sciences & Biomedicine; Medicine, General & Internal; General & Internal Medicine; micro-invasive glaucoma surgery; minimally invasive; glaucoma; excimer laser trabeculostomy; intraocular pressure; treatment; ELT; MIGS; guidance; laser; OPEN-ANGLE GLAUCOMA; TRABECULOPLASTY; PHACOEMULSIFICATION; TRABECTOME; EFFICACY

Abstract

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.