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

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Abstract

Excimer laser trabeculostomy (ELT) is a safe and effective micro-invasive glaucoma surgery (MIGS) procedure for the reduction of both intraocular pressure (IOP) and pressure-lowering medications in patients with open-angle glaucoma. Significantly less invasive relative to most current glaucoma surgical procedures, ELT preserves the integrity of the meshwork and Schlemm's canal, restoring natural outflow without the creation of blebs or the implantation of foreign bodies. Compared to filtering procedures such as trabeculectomy, ELT not only reduces the number of postoperative visits required to assure adequacy and stability but also eliminates most postoperative risks in both short and long terms. By minimizing the healing responses induced by tissue trauma and thermal effects inherent to other MIGS procedures, ELT enables a consistent lowering of IOP on a long-term basis. Furthermore, due to the minimal tissue trauma associated with tissue trauma associated with ultra-violet (UV) tissue photoablation, only a few small channels into Schlemm's canal have proven adequate to control the IOP. In addition, ELT can be readily performed concurrent with lensectomy with significant long-term pressure-lowering effects far greater than lensectomy alone, allowing the physician to address two pathologies in one surgical intervention.

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Notes

  1. 1.

    Target tissue anatomic considerations to minimize healing responses must specifically address minimizing trauma to the outer wall of SC. The outer wall endothelium contains fibroblasts, whereas the inner wall endothelium does not. Thus, avoiding trauma to the outer wall and thereby not stimulating a fibroblast response is paramount to the successful maintenance of outflow. Another anatomic consideration is the space between the inner and outer walls of SC, which can be less than 20 μm. The accuracy of the tool used to enter the inner wall such that it does not disturb the outer wall must be of this same scale. The ablation precision of 308 nm on this tissue, unlike that of lasers and devices utilized in earlier attempts to fistulize SC, facilitates the non-thermal and accurate tissue removal which thereby enables the ELT procedure’s efficacy.

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Author information

Authors and Affiliations

  1. Glaucoma Institute of Beverly Hills, Jules Stein Eye Institute, UCLA, 8733 Beverly Blvd., Suite 301, Los Angeles, CA, 90048, USA

    Michael S. Berlin MD, MS

  2. Department of Ophthalmology, University Hospital Zurich, Frauenklinikstrasse 24, Zurich, 8091, Switzerland

    Marc Töteberg-Harms MD

  3. Glaucoma Institute of Beverly Hills, 8733 Beverly Blvd., Suite 301, Los Angeles, CA, 90048, USA

    Edward Kim BA & Iris Vuong

  4. Augen-klinik OWL, Detmold, Elisabethstrasse 85, 32756, Detmold, Germany

    Ulrich Giers MD

Authors
  1. Michael S. Berlin MD, MS
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  2. Marc Töteberg-Harms MD
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  3. Edward Kim BA
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  4. Iris Vuong
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  5. Ulrich Giers MD
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Corresponding author

Correspondence to Michael S. Berlin MD, MS .

Editor information

Editors and Affiliations

  1. Department of Surgery, Rocky Vista University, Parker, CO, USA

    John R. Samples MD

  2. Western Glaucoma Foundation, Portland, OR, USA

    John R. Samples MD

  3. Cornea Consultants of Colorado, Littleton, CO, USA

    John R. Samples MD

  4. The Eye Clinic, Portland, OR, USA

    John R. Samples MD

  5. Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada

    Iqbal Ike K. Ahmed MD, FRCSC

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Berlin, M.S., Töteberg-Harms, M., Kim, E., Vuong, I., Giers, U. (2014). Excimer Laser Trabeculostomy (ELT): An Effective MIGS Procedure for Open-Angle Glaucoma. In: Samples, J.R., Ahmed, I.I.K. (eds) Surgical Innovations in Glaucoma. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8348-9_8

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  • DOI: https://doi.org/10.1007/978-1-4614-8348-9_8

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  • Print ISBN: 978-1-4614-8347-2

  • Online ISBN: 978-1-4614-8348-9

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