Excimer Laser Trabeculostomy (ELT) in Glaucoma Treatment

March 21, 2009

I recently read about a new procedure for glaucoma. The surgeon makes a small incision to access the anterior chamber (often using the phaco wound during phaco) and under a goniolens (like a Koeppe lens) or using an endoscope, applies a special probe to the distal trabecular meshwork and ablates until the Schlemm’s canal is reached (some blood reflux is noted at this point). About ten openings are made. The results looked pretty good, and what’s nice is that ther’s no bleb and no bridges are burned- can always do a trab later. Apparently it has been used in Europe for several years with good success.

 

 



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5 Responses to “Excimer Laser Trabeculostomy (ELT) in Glaucoma Treatment”

  1. Irv Arons on March 22nd, 2009 12:16 am

    If this is the Trabectome, it is not a laser, just an electrocautery. Here is a link explaining the technique:
    http://www.trabectome.com/Technology/TrabectomeSystem/

    Years ago, Summit Technology tried to form a “window” in the sclera using their excimer laser. Energy was applied until fluid started to exude, which stopped the laser action. It was called PET or partial excimer trabeculoplasty. It was not pursued. I wrote this up either in one of my OSN articles or one of the many reports I wrote, when I was involved in reporting on the beginnings of refractive surgery.

    More recently, an Israeli company has been trying to do the same thing, using a CO2 laser — again applying energy until the exuding fluid stops the tissue interaction. I have been in touch with them, but so far they have not responded.

    Irv Arons

  2. Dr. Weitzner on March 22nd, 2009 3:16 am

    no- not the trabecutome. its called excimer laser trabeculostomy (elt). its written up in glaucoma today (march 2009).

  3. Irv Arons on March 22nd, 2009 11:45 am

    I found the article. It’s by an old friend, Michael Berlin, and he is using a XeCl 308 nm excimer laser. As he states in the article, the 193 ArF laser can’t be used with fibers, but has to be used directly, while the 308 XeCl laser can. And, that’s what he used.

    Here is the link to the article:

    http://www.glaucomatoday.com/articles/0309/GT0309_08.php

    Irv Arons

  4. Dr. Weitzner on March 22nd, 2009 1:43 pm

    thanks for the follow-up!

  5. Irv Arons on March 22nd, 2009 4:56 pm

    More on ELT – when Michael Berlin’s name came up being associated with the ELT procedure, it sparked my memory of a meeting I had with him at one of the AAO meetings – so I looked it up in my files. Sure enough, I wrote about ELT in a writeup about the 2001 AAO meeting.

    The following excerpt appears in my “Technology Update” column of that AAO meeting, that appeared in the January 15, 2002 issue of Ocular Surgery News (see the last paragraph).

    Link: http://www.osnsupersite.com/view.aspx?rid=13245

    Excerpt:

    Lasers for glaucoma

    Selective laser trabeculoplasty (SLT) using the Selecta 7000 doubled YAG laser, developed by Coherent Medical (now part of Lumenis), is a relatively new option for treating open-angle glaucoma. I was told by the company that the procedure was being done extensively and that laser sales were “going extremely well,” but there was no mention of how many systems have actually been placed into use. The new version of the laser, called the Selecta II, sells for $60,000 both as a fixed and portable office system.

    With the apparent acceptance of this technique, it was to be expected that others would develop a short pulse/large spot-size version of a doubled YAG to join Lumenis in the market. That is exactly what has happened. Glautec, of Nuremberg, Germany, has introduced its Otello SLT laser, with a short pulse of 4 ns and two spot sizes – either 400 ?m or 700 ?m. (Lumenis’ Selecta II operates at 3 ns with a 400-?m spot.) The Otello, available only in Europe because of Lumenis’ U.S. patent protection, sells for $39,000. The company claims to have sold four to five systems in Europe.

    Glautec also showed its Aida excimer laser for excimer laser trabeculotomy (ELT). This 308-nm excimer laser is used ab interno to gently create holes through the trabecular meshwork and into Schlemm’s canal. Because the excimer wavelength ablates tissue without collateral thermal damage, the edges of the holes are smooth, which helps minimize wound healing and maintain the openings.

    According to the company, only a few laser pulses are needed to create a permanent opening, and six to eight holes are enough to reduce outflow resistance and intraocular pressure. The treatment time is only a few minutes, and postoperative ocular irritations are minimal. Company man agement claims that the procedure can be used in up to two-thirds of primary open-angle glaucoma cases, and that more than 2,000 patients have been treated to date.

    Again, because of an interfering U.S. patent (held by Dr. Michael Berlin), the laser is sold only internationally. There are more than 30 systems currently in use, with the expectation that there will be 40 in operation by the end of 2000. The laser sells for between $70,000 and $90,000, with the fiber needed for delivery of its laser energy selling for $130 to $150 each.

    I have contacted Dr. Berlin, and will find out if he is using the Glautec excimer, or someone elses.

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