Efficacy and safety of ELIOS excimer laser trabeculostomy versus iStent inject as an adjunct to phacoemulsification: a retrospective comparative study

Background/aims Minimally invasive glaucoma surgery (MIGS) procedures are commonly combined with phacoemulsification to provide additional intraocular pressure (IOP) and/or topical medication reduction in patients with mild-to-moderate glaucoma. This study compared the 1-year efficacy and safety of excimer laser trabeculostomy (ELIOS) versus trabecular micro-bypass stenting (iStent inject and iStent inject W), both performed in combination with cataract surgery. Methods This multicentre retrospective cohort study included patients undergoing combined phacoemulsification with either ELIOS (Phaco-ELIOS) or iStent implantation (Phaco-iStent) at three European centres between 2020 and 2025. The primary endpoint was IOP at 12 months postoperatively. Secondary endpoints included longitudinal IOP and medication use, surgical success, adverse events and the need for secondary glaucoma surgery. Longitudinal outcomes were analysed using multiple imputation. Results A total of 343 eyes were included (164 Phaco-ELIOS and 179 Phaco-iStent), with 1-year follow-up available in 70%. Mean IOP decreased by 21.6% for Phaco-ELIOS and 20.7% for Phaco-iStent and remained stable through 12 months (p=0.74). Both procedures were associated with a similar reduction in postoperative topical glaucoma medications (0.56 vs 0.41; p=0.2). With Phaco-ELIOS, a higher proportion of eyes achieved medication reduction (46.4% vs 31.3%; p=0.02). Rates of adverse events and secondary glaucoma surgery were low and comparable in both groups. Conclusion Phaco-ELIOS and Phaco-iStent provided comparable 1-year IOP reduction and overall safety. Phaco-ELIOS showed a greater number of patients with topical medication reduction, supporting its role as an effective combined MIGS option in patients undergoing cataract surgery.