AGS 2025: Long-term efficacy and safety of standalone and phaco ELT with Marc Toeteberg-Harms, MD

Marc Toeteberg-Harms, MD, FEBO, provided highlights from a meta-analysis evaluating the safety and efficacy of excimer laser trabeculostomy (ELT) in glaucoma and ocular hypertension at the 2025 American Glaucoma Society Annual Meeting, held February 26 to March 2, in Washington, DC. This poster was selected as a Top Poster Presentation of the meeting by AGS.

Toeteberg-Harms, based in Iowa City at the University of Iowa’s Department of Ophthalmology and Visual Sciences, noted that ELT, a minimally invasive glaucoma surgery (MIGS) procedure performed in Europe since the 1990s, has shown promise in reducing IOP and medication burden without the need for implants. Analyzing 14 studies, the meta-analysis found that ELT—either standalone or combined with cataract surgery—achieved an average IOP reduction of 3 mm Hg to 10 mm Hg and a medication reduction of up to 1.8 medications. Complication rates were low, with mild, self-resolving hyphema being the most common. An additional long-term study following 161 eyes over eight years revealed that only 13% required further glaucoma surgery beyond laser trabeculoplasty.

ELT utilizes an excimer laser in an ab interno approach, creating 10 microchannels (approximately 210 µm in diameter) through the trabecular meshwork to improve aqueous outflow via Schlemm’s canal. Unlike thermal-based techniques, ELT's photoablative mechanism avoids heat-related damage, preserving trabecular meshwork integrity and minimizing scarring or fibrosis.

Ongoing research includes two FDA IDE trials evaluating ELT as a standalone and combination procedure, as well as a randomized controlled trial in Europe comparing ELT with iStent inject. A key advantage of ELT is its implant-free nature, addressing concerns about endothelial cell loss seen with previous MIGS implants like CyPass, according to Toeteberg-Harms. Notably, long-term observations suggest ELT channels remain patent, even years post procedure.

Preliminary data also indicate ELT may be effective in pseudoexfoliative glaucoma, further expanding its potential indications. As ELT progresses through the FDA-approval process, it may soon offer US ophthalmologists a viable, implant-free MIGS option for glaucoma management.