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Publications

Journal Article Ahead of print

PubMed: 42660628 DOI: 10.1136/bjo-2026-329700

Efficacy and safety of ELIOS excimer laser trabeculostomy versus iStent inject as an adjunct to phacoemulsification: a retrospective comparative study.

Br J Ophthalmol

Authors: Thomas Jacobs, Ronald M P C De Crom, Jan Van Eijgen, Vincent Walgrave, Mehmet Ikinci, Matthew Hochuen Ip, Nathan M Kerr, Neeru A Vallabh, Keith Barton, Keith R Martin, Dan Lindfield, Henny J M Beckers, Gokulan Ratnarajan, Ingeborg Stalmans

Affiliations

  • Research Group Ophthalmology, KU Leuven Department of Neurosciences, Leuven, Flanders, Belgium.
  • Centre for Eye Research Australia Ltd, East Melbourne, Victoria, Australia.
  • Ophthalmology, UZ Leuven, Leuven, Flanders, Belgium.
  • Ophthalmology, Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia.
  • Universiteitskliniek voor Oogheelkunde, Maastricht Universitair Medisch Centrum+, Maastricht, Limburg, Netherlands.
  • Research Group Ophthalmology, KU Leuven Department of Neurosciences, Leuven, Flanders, Belgium.
  • Eye Unit and Eye Bank, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, UK.
  • Department of Eye and Vision Science, University of Liverpool, Liverpool, UK.
  • St. Paul's Eye Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.
  • University College London Institute of Ophthalmology, London, UK. NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK.
  • Glaucoma, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia.
  • Glaucoma Services, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK.

Abstract

BACKGROUND/AIMS

Minimally invasive glaucoma surgery (MIGS) procedures are commonly combined with phacoemulsification to provide additional intraocular pressure (IOP) and/or topical medication reduction in patients with mild-to-moderate glaucoma. This study compared the 1-year efficacy and safety of excimer laser trabeculostomy (ELIOS) versus trabecular micro-bypass stenting (iStent inject and iStent inject W), both performed in combination with cataract surgery.

METHODS

This multicentre retrospective cohort study included patients undergoing combined phacoemulsification with either ELIOS (Phaco-ELIOS) or iStent implantation (Phaco-iStent) at three European centres between 2020 and 2025. The primary endpoint was IOP at 12 months postoperatively. Secondary endpoints included longitudinal IOP and medication use, surgical success, adverse events and the need for secondary glaucoma surgery. Longitudinal outcomes were analysed using multiple imputation.

RESULTS

A total of 343 eyes were included (164 Phaco-ELIOS and 179 Phaco-iStent), with 1-year follow-up available in 70%. Mean IOP decreased by 21.6% for Phaco-ELIOS and 20.7% for Phaco-iStent and remained stable through 12 months (p=0.74). Both procedures were associated with a similar reduction in postoperative topical glaucoma medications (0.56 vs 0.41; p=0.2). With Phaco-ELIOS, a higher proportion of eyes achieved medication reduction (46.4% vs 31.3%; p=0.02). Rates of adverse events and secondary glaucoma surgery were low and comparable in both groups.

CONCLUSION

Phaco-ELIOS and Phaco-iStent provided comparable 1-year IOP reduction and overall safety. Phaco-ELIOS showed a greater number of patients with topical medication reduction, supporting its role as an effective combined MIGS option in patients undergoing cataract surgery.

MeSH

Eye, Safety, Ophthalmology, Phacoemulsification, Lasers, Excimer, Drug-Related Side Effects And Adverse Reactions, Lasers, Glaucoma, Cataract