ESCRS 2026: ELIOS excimer laser trabeculostomy shows sustained IOP reduction, high medication-free rates at 2 years

Study design

At the 2026 ESCRS Congress in London, Cathleen McCabe, MD, presented 2-year outcomes from a trial of the ELIOS System (Bausch + Lomb), an excimer laser platform that creates 10 fenestrations — each 210 μm in diameter — in the trabecular meshwork to increase aqueous outflow in patients with mild to moderate glaucoma. McCabe, who practises cataract and refractive surgery on the west coast of Florida and has been involved in numerous MIGS trials, said the procedure leaves no device behind.

The study enrolled 318 patients who completed the 2-year cohort. Inclusion criteria required a medicated intraocular pressure (IOP) of 24 mmHg or less, and an unmedicated IOP between 22 and 34 mmHg. Investigators collected the mean unmedicated diurnal IOP reduction, the proportion of patients achieving a 20% or greater reduction, exact mean IOP, adverse events, and—according to McCabe, the most patient-relevant measure—the proportion of patients who became medication-free.

Results

At 12 months, McCabe reported a mean IOP reduction of more than 8 mmHg, with 84% of patients achieving a meaningful reduction of at least 20%. Medication-free rates were 86% at 12 months and 84% at 2 years, which McCabe described as producing “a nice, flat graph” reflecting a sustained improvement in quality of life. At 24 months, she reported an average unmedicated IOP of 24.5 mmHg and an average reduction of at least 8 mmHg.

Clinical implications

McCabe said reducing patients' reliance on topical drops is among her top priorities as a refractive cataract surgeon, citing the cost, convenience, and compliance burden of drops, as well as concerns about ocular surface toxicity and patients' overall quality of vision. She described ELIOS as an implant-free procedure with a short learning curve that can help surgeons improve both quality of life and IOP control in patients with mild to moderate glaucoma.