ESCRS 2026: femtosecond laser trabeculotomy sustains 27% IOP reduction at 48 months in open-angle glaucoma

At the 44th Congress of the European Society of Cataract and Refractive Surgeons (ESCRS), held 11-15 September 2026 in London, Zoltan Z. Nagy, MD, PhD, FEBO, FACS, chair of the Department of Ophthalmology at Semmelweis University in Budapest, Hungary, presented 48-month outcomes for femtosecond laser image-guided high-precision trabeculotomy (FLigHT), a non-incisional procedure for open-angle glaucoma.

Study design

Four years earlier, Nagy's group created a 500-by-200-micrometre incision in the trabecular meshwork using the FLigHT device and followed patients prospectively. Intraocular pressure (IOP) was measured by Goldmann tonometry, visual acuity and overall ocular health were monitored, and optical coherence tomography (OCT) was used to track the incisions over time.

Efficacy at 48 months

Mean IOP decreased by 27%, from a baseline of 21.4 mmHg to a stable 14.9 mmHg, an effect Nagy said was maintained throughout follow-up. He noted the procedure may offer open-angle glaucoma patients a 27% to 30% reduction from baseline pressure over the long term. Anti-glaucoma treatment was continued during follow-up, though Nagy said some patients on multiple medications were able to reduce their regimen by two drops, raising the prospect of reduced or even discontinued drop therapy in select patients.

Safety

Vision deterioration occurred in two patients: one lost two lines of visual acuity, and one developed a cataract that was later operated on, after which vision and IOP returned to levels comparable with the post-FLigHT baseline. OCT imaging showed all incisions remained stable across 48 months, with no fibrosis, inflammation, or occlusion. Nagy reported no other side effects, including no bleeding in the anterior chamber and no infection risk, attributing this to the procedure's non-incisional approach—the eye is not opened during treatment. He contrasted this with classical trabeculectomy, after which IOP can swing to very high or very low extremes, a particular concern in advanced glaucoma because of the risk of further damage to retinal ganglion cells.

Clinical outlook

Nagy said the FLigHT system, including its patient interface and step-by-step programming, is now ready for clinical use and is commercially available in Europe, including the UK. Based on the 48-month data, he suggested the procedure could become a long-term option for lowering IOP in open-angle glaucoma without the risks associated with incisional surgery.