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Purpose: Excimer laser trabeculostomy (ELT) is a minimally invasive glaucoma surgery that creates microperforations in the trabecular meshwork to restore physiological aqueous outflow. Unlike stent- or implant-based approaches, ELT leaves no permanent foreign body in the eye. The purpose of this study was to evaluate the 12-month effectiveness of ELT in reducing intraocular pressure (IOP) and topical glaucoma medication burden in a real-world clinical setting.

Methods: This was a prospective, non-randomised, 12-month trial at the ARTEMIS Eye Centers Frankfurt as part of a post-market clinical follow-up programme, conducted between November 2023 and March 2025. A total of 172 eyes from 131 patients were included. Diagnoses comprised primary open-angle glaucoma (85%), pseudoexfoliation glaucoma (10%), ocular hypertension (2%), and pigmentary glaucoma (2%). Mean±SD patient age was 73.1±9.7 years, and 62% were female. Glaucoma severity was classified as mild (40%), moderate (34%), or severe (26%). The primary outcome measures were change in IOP and change in number of ocular hypotensive medications from baseline to 12 months postoperative. Rate of secondary surgical interventions (SSIs) was also recorded. All IOP measurements were obtained under current topical medication (no washout). The ELIOS ELT procedure was performed using a laser probe to create 10 perforations (~210 µm in diameter) in the trabecular meshwork along the nasal circumference; 94% of procedures were combined with cataract surgery.

Results: Mean±SD IOP decreased from 21.9±4.4 mmHg at baseline to 14.7±5.3 mmHg at 12 months, representing a 33% reduction (p<0.001). Mean number of ocular hypotensive medications decreased from 1.7±1.2 to 0.7±0.8 (-60%) at 12 months. At 12 months, 53% of eyes were medication-free, 84% achieved an IOP ≤18 mmHg, and 68% achieved an IOP =15 mmHg. Fourteen eyes (8%) required a SSI within the 12-month follow-up period.

Conclusions: This study demonstrated improvement in IOP (33%) and number of medications (60%) at 12 months of follow-up in a real-world population. This reduction in IOP meets the European Glaucoma Society-recommended target for mild-to-moderate glaucoma of (≥25% reduction to below 17 mmHg), and therefore can be considered clinically meaningful as well as statistically significant. The high proportion of medication-free eyes (54%) and the favourable safety profile support ELT as an effective, implant-free, therapeutic option in the surgical management of glaucoma.