The AIDA and the extra laser systems for excimer laser trabeculotomy proved comparable IOP lowering efficacy—12-month results

Sufian Hommayda,Marc Töteberg-Harms,Timothy Hamann

doi:10.1007/s10792-021-02140-1

Abstract

PurposeCataract surgery combined with excimer laser trabeculotomy (phaco-ELT) leads to a significant reduction in intraocular pressure by enhancing trabecular outflow. The aim of this study is to compare two laser systems for ELT (AIDA vs. ExTra).MethodsIn this retrospective chart review, inclusion criteria were a diagnosis of glaucoma and phaco-ELT between 07/17/2010 and 07/17/2018. Data were collected preoperatively and postoperatively up to 1 year. Success was defined as IOP reduction of ≥ 20% compared to baseline plus an IOP of < 21 mmHg with no hypotony, no loss of light perception vision, and no subsequent glaucoma surgery.ResultsThree hundred and fourteen eyes (mean age 75.9 ± 8.6 years) were included. Baseline intraocular pressure (IOP) for the ExTra group (94 eyes) was 20.3 ± 5.9 mmHg on 2.0 ± 1.3 anti-glaucoma drugs (AGD) and a best-corrected visual acuity (BCVA, logMar) of 0.5 ± 0.4. For The AIDA group (220 eyes), baseline IOP was 18.7 ± 6.3 mmHg on 2.0 ± 1.3 AGD and a BCVA of 0.3 ± 0.3. In the ExTra group, IOP was reduced to 12.8 ± 2.5 mmHg (−37%) and in the AIDA group to 14.7 ± 3.9 (−21%, p = 0.14) at 1 year. AGD reduction in the ExTra group was 1.3 ± 1.5 and 1.8 ± 1.4 in the AIDA group (p = 0.14). Success rates were 80% (ExTra) and 70% (AIDA), respectively (p = 0.552). Thirty-one eyes (10.0%) required a subsequent glaucoma surgery during the follow-up.ConclusionBoth laser platforms, the ExTra and the AIDA laser, used for Phaco-ELT lead to a significant reduction in intraocular pressure and anti-glaucoma drugs with no statistically significant difference in success rates during the follow-up of 12 months.Trial Registration Swissethics: 2018–01,791.

Highlights

An estimated 2.9 million people are blind due to glaucoma with increasing numbers, making glaucoma one of the leading causes of irreversible blindness worldwide [1]
Outcome parameters were defined as intraocular pressure (IOP), bestcorrected visual acuity (BCVA), number of anti-glaucoma drugs (AGD), and the occurrence of complications
Average number of required AGD was reduced from 2.0 ± 1.3 to 1.5 ± 1.5 in the ExTra group and to 1.8 ± 1.4 in the a fiber diameter of μm (AIDA) group

Summary

Introduction

An estimated 2.9 million people are blind due to glaucoma with increasing numbers, making glaucoma one of the leading causes of irreversible blindness worldwide [1]. The only evidence-based treatment for glaucoma is lowering intraocular pressure to slow down disease progression [4,5,6,7,8]. MIGS procedures cover a field of evidence-based techniques to treat glaucoma with a lower risk profile compared to trabeculectomy, faster recovery, and, the reduced necessity of frequent postoperative visits and fewer postoperative complications [10]. In ELT, a pulsed xenon chloride excimer laser connected to a quartz fiber optic probe non-thermally creates ten laser channels with a diameter of approximately 200–210 μm each through the trabecular meshwork and the inner wall of Schlemm’s canal. The physiological trabecular (conventional) outflow is increased or restored, and IOP is consecutively reduced. Blood reflux into the anterior chamber at the end of an ELT procedure, which is commonly observed, proves laser channels from the anterior chamber into Schlemm’s canal are patent [11]

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