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Purpose: A growing number of microinvasive glaucoma surgery (MIGS) techniques have been developed to achieve effective intraocular pressure reduction with a more favorable safety profile than filtrating procedures. This study evaluates short-term surgical outcomes and early complications of excimer laser trabeculostomy (ELT) using the non-thermal ELIOS laser system (Bausch & Lomg, Rochester, NY, USA) in patients with chronic glaucoma.

Methods: Retrospective, single center study at the Department of Ophthalmology at the Medical University of Graz, Austria. Included are adult patients that underwent ELT using the ELIOS laser system in combination with cataract surgery between June 2024 and December 2025. The primary endpoint is change in intraocular pressure (IOP) at 3 months after surgery compared to baseline with particular focus on the early postoperative course. Secondary outcomes include medication burden, surgical success, early complications and rate of reoperation.

Results: Between June 2024 and December 2025, a total of 40 eyes from 34 patients were included in the study. All procedures were performed as combined surgeries, consisting of ELT and cataract surgery. Mean diurnal IOP decreased from 21.5 (SD: 6.3) mmHg at baseline to 14.4 (2.5) mmHg at 3 months postoperatively, corresponding to a mean reduction of 7.1 mmHg (95%- CI: 3.3 – 10.8 mmHg, p < 0.001). At week 1, the only observed complication were transient IOP spikes and increased anterior chamber inflammation in six patients (15.0%), requiring additional visits in all affected patients. Mean IOP during these spikes was 36.7 (SD: 3.0) mmHg with mild-to-moderate cells in the anterior chamber. In most cases, IOP and inflammation were successfully controlled with short-term oral acetazolamide therapy and local steroids. Additional IOP-lowering intervention was required in one patient (2.5%), who declined further filtering surgery and instead underwent micropulse transscleral cyclophotocoagulation. Two patients (5.0%) developed macular edema. All complications occurred within the first postoperative month (mean: 22, SD: 12.9 days). The dropout rate at 3 months was 57.5%.

Conclusion: Combined ELT and cataract surgery resulted in a significant and clinically relevant reduction in IOP at 3 months. The procedure demonstrated a favorable safety profile, with mostly transient and manageable postoperative complications in the form of IOP spikes and increased anterior chamber inflammation. Early postoperative monitoring remains essential due to the relatively high occurrence of short-term IOP spikes and inflammation.