Abstract
Purpose :
The Hydrus microstent (Ivantis, Irvine, CA) is a minimally invasive glaucoma surgery (MIGS) that spans approximately 90 degrees of the Schlemm’s canal to improve trabecular outflow. Hydrus is FDA-approved to be performed in combination with cataract surgery in patients with mild to moderate open angle glaucoma. We performed this study to evaluate the safety and efficacy of phaco-Hydrus in patients stratified by severity of open angle glaucoma.
Methods :
We completed a retrospective chart review of Hydrus microstent combined with phacoemulsification cataract extraction with intraocular lens implantation (phaco-Hydrus) performed in 22 eyes of 21 patients with mild/moderate (n=11) or severe (n=11) primary open angle glaucoma or normal tension glaucoma at a single academic site from 7/2020 to 7/2021. Mean age was 73.29 ± 7.27 years, 62% patients were Caucasian and 29% African American, and 95% were male. The average follow up was 5.95 ± 3.15 months (range 3-12 months). Surgical technique included insertion of the Hydrus microstent into the Schlemm’s canal nasally. Data is reported as mean ± standard deviation, and comparisons were made of pre-operative and three-month data using paired Student's t-tests.
Results :
At three months postoperatively, the average IOP reduction for all open angle glaucoma patients receiving phaco-Hydrus was -2.55 ± 3.77 mmHg (-24.02 ± 39.00%) (P = 0.0047). The average drop reduction was -0.50 ± 0.91 (P = 0.018). Average IOP reduction for mild to moderate open angle glaucoma was 1.0 ± 3.2 (P = 0.33) and average drop reduction was 0.64 ± 0.81 (P = 0.026). Average IOP reduction for severe open angle glaucoma was 4.09 ± 3.76 (P = 0.0048) and average drop reduction was 0.36 ± 1.03 (P = 0.27). Phaco-Hydrus in patients with severe open angle glaucoma resulted in greater IOP reduction than in mild to moderate glaucoma (P = 0.052). None of the patients required an additional glaucoma surgery during the follow-up period.
Conclusions :
The combination of the Hydrus microstent with phacoemulsification cataract surgery results in significant IOP reduction for patients with all stages of open angle glaucoma, including severe. Greater IOP reduction was observed in patients with severe stage compared to mild to moderate stage open angle glaucoma. Phaco-Hydrus may be an effective option for patients with severe open angle glaucoma.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.