AAO 2026: 24-month outcomes of excimer laser trabeculostomy

Excimer laser trabeculostomy (ELT) performed with cataract surgery maintained or lowered intraocular pressure (IOP) and reduced medication use through 24 months in patients with open-angle glaucoma, according to Mark J. Gallardo, MD, of El Paso Eye Surgeons. Gallardo presented the findings in a poster at the American Academy of Ophthalmology (AAO) 2026 Annual Meeting, held October 9-12 in New Orleans, Louisiana.

Gallardo explained that the excimer laser has been used in refractive surgery for 3 decades and has been modified to ablate tissue in the eye’s natural outflow system. The procedure creates 210-μm channels within the pigmented trabecular meshwork. Because the laser is non-thermal, he said, there is no collateral damage to adjacent tissue, resulting in clean, full-thickness channels in the proximal outflow system.

Gallardo noted that a reduction in mean diurnal IOP of at least 20% has long been the gold standard in clinical trials, and a large proportion of patients in the study achieved it, similar to what has been seen with other minimally invasive glaucoma surgery procedures. He also emphasized the medication results, since glaucoma care now aims to improve quality of life, not only control disease. “We’re able to maintain pressure or reduce pressure and also reduce the medication burden,” he said.

Adverse events in the early postoperative period were similar to those of cataract surgery alone, according to Gallardo. They were self-limiting and tended to resolve with minimal therapy. Any hyphema was micro-hyphema with circulating red blood cells and did not affect visual acuity, and patients’ recovery was similar to that of cataract surgery alone. Endothelial cell density declined and then stabilized after 3 months; Gallardo attributed this to the cataract surgery rather than the laser.

Study design and long-term outlook

The study was prospective and single-arm, which Gallardo acknowledged will draw some skepticism. Because combined procedures have become so common in patients with glaucoma undergoing cataract surgery, he said, assigning patients to cataract surgery alone raised ethical questions. The FDA allowed the single-arm design, and the investigators used historical data from 3 other pivotal trials to set performance standards for each end point.

The study will not be extended beyond 24 months, and Gallardo said longer-term data will be needed once the procedure becomes available. “In glaucoma management, nothing lasts forever,” he said. Still, because the laser does not ablate a large swath of tissue, a failure over time leaves options open. “We haven’t burnt any bridges,” Gallardo said, noting that surgeons can return to the outflow system with canaloplasty, a larger goniotomy, or stents.