A laboratory study examining a novel laser-based glaucoma procedure suggests that creating multiple drainage channels may enhance aqueous outflow more effectively than a single channel approach. The technique, known as femtosecond laser image-guided high-precision trabeculotomy (FLIGHT), uses the ViaLase laser system to form a channel between the anterior chamber and Schlemm’s canal without incisional surgery. Lowering intraocular pressure remains the only proven strategy for slowing glaucoma progression, yet many patients require multiple medications or invasive procedures to reach target levels.
In this experimental study, investigators evaluated 8 pairs of perfused human anterior-segment tissues using the iPerfusion 3 system. Within each pair, 1 eye received a single laser-created channel, while the contralateral eye received 2. The goal was to determine whether increasing the number of channels would further improve outflow facility, a key determinant of intraocular pressure.
The findings indicated a measurable difference. Eyes treated with a single channel demonstrated an average outflow facility of 0.27±0.01 µL/min/mmHg, compared with 0.39±0.13 µL/min/mmHg in eyes treated with 2 channels—a statistically significant increase. Immunofluorescent imaging of the flow pathways showed that when channels were created in regions of low flow, flow increased fluid movement to effectively match the levels seen in higher-flow regions.
Although limited to an ex vivo model, the results provide mechanistic support for refining laser trabeculotomy techniques. The data suggest that targeting multiple sites within the outflow pathway may enhance fluid dynamics and potentially improve pressure control, a hypothesis that would require confirmation in clinical settings.
“The FLIGHT procedure represents a precise, image-guided, incision-free approach to trabeculotomy that gives surgeons more control over how they engage the conventional outflow pathway,” said Iqbal K. “Ike” Ahmed, MD, FRSCS, Professor and Director of Alan S. Crandall Center for Glaucoma Innovation, John A. Moran Eye Center, University of Utah and the Senior Investigator on the Optimizing Outflow Facility with ViaLase Femtosecond Laser Trabeculotomy study. “The ability to tailor treatment based on anatomy is particularly important. That combination of safety, flexibility, and control is very compelling for surgeons.”
The ViaLase FLIGHT system is undergoing a pivotal clinical trial for FDA clearance, and it received CE Mark in the European Union in July 2024.