Elios Vision is taking a breakthrough approach to surgical glaucoma management with a next generation excimer laser platform, ELIOS. Unlike traditional MIGS, ELIOS is an implant-free procedure that uses a highly precise, nonthermal excimer, laser to enhance the natural outflow pathway. The laser creates 10 microchannels (210-µm diameter) through the trabecular meshwork and the procedure can be elegantly performed at the time of cataract surgery (Figure 1) or standalone. In my experience, ELIOS holds great promise to address open angle glaucoma.
To embark on a swift learning curve with ELIOS, I recommend that new users focus on the following five key steps.
No. 1: Visualization. A clear view of the angle structures is crucial so practice and experience with surgical gonioscopy is helpful. Remember to tilt the microscope to between 40-45 degrees and rotate the patient’s head away from you to improve visualization of the angle. Relax the patient to avoid eye movement during the procedure.
No. 2: Preparation and calibration. Work with your operating room team to have the laser calibrated and ready to go by the time you want to perform ELIOS. I ask my team to prepare the laser during the final stages of Phaco in order to integrate the procedure seamlessly without delay which is better for me and the patient.
No. 3: Surgical technique. Given the use of topical anesthesia, patient movement is possible. Create a relaxed environment for both you and the patient. At the end of the ELIOS procedure, take time to remove any blood reflux which may have appeared around the microchannels. Incidentally, blood reflux is a positive indication of a patent connection.
No. 4: Planning of probe tip placement. Plan to treat an area of approximately 90-110 degrees over the infero- and supero-nasal TM, therefore ensure your main incision location is positioned accordingly. Ensure the bevel is correctly oriented and achieves light contact with the TM during laser exposure. Space each microchannel approximately one probe width apart with the centre of the probe in line with the junction between the pigmented and nonpigmented TM.
No. 5: Optimize postoperative regimen. My post-operative steroid and antibiotics regimen is the same as with routine phaco, so tapering steroids down over a 4 week period. Personally I stop IOP lowering medications although some surgeons may prefer to continue medications with some patients, for example, if they are using >2 medications pre-operatively.
Figure 1. Microchannels are created in the trabecular meshwork during the ELIOS procedure 31 months post-operatively.
Courtesy of Dr Antonio Moreno-Valladares
By embracing these steps, the learning curve for this technology can be optimized.
