Abstract
Purpose :
The effectiveness and safety of the Hydrus Microstent combined with phacoemulsification in
managing pseudoexfoliation glaucoma remains unclear and currently off-label. This study
seeks to clarify these aspects by comparing the safety and efficacy of trabecular stents in
pseudoexfoliation and primary open angle glaucoma patients over a one-year period.
Methods :
A retrospective study was conducted on primary open-angle glaucoma (POAG) and
pseudoexfoliation glaucoma (PXG) patients who received Hydrus Microstent with
phacoemulsification. Inclusion criteria allowed patients with prior laser treatments but excluded
those with previous glaucoma surgeries. We assessed the mean ocular hypotensive
medications and intraocular pressure (IOP) preoperatively, and at 1 and 12 months
postoperatively, along with complications and secondary surgical interventions (SSI). Surgical
success, our primary outcome, was defined as achieving target IOP at 12 months without
additional medications or procedures. Eyes were matched (1:1) on baseline demographics,
baseline and target IOP, and baseline number of medications. Statistical analyses employed
chi-squared and independent and paired t-tests.
Results :
In our 68-eye cohort (34 PXG, 34 POAG), the mean baseline IOP and medications were 17.6 ±
5.7 mmHg and 2.07 ± 1.19, respectively. At 12 months, surgical success was achieved in 61.7%
of PXF and 58.8% of POAG patients (p>0.05). The mean IOP reduction at 1 month was 16.5%
in PXF (p<0.05) and 10.1% in POAG (p>0.05); at 12 months, it was 19.6% in PXF (p<0.05) and
13.6% in POAG (p<0.05). Medication reduction at 1 month was 15.4% in PXF (p>0.05) and
50.6% in POAG (p<0.001); at 12 months, it was 40.8% in PXF (p<0.05) and 51.2% in POAG
(p<0.05). Adverse events occurred in both groups, including corneal edema, steroid response,
and hyphema. Neither group received SSI.
Conclusions :
The study confirms the Hydrus Microstent's effectiveness in reducing intraocular pressure and
medication use in pseudoexfoliation glaucoma, comparable to primary open-angle glaucoma.
Furthermore, the medication lowering effect of Hydrus in PXG was noninferior to that of POAG.
Notably, most complications, including cystoid macular edema and ERM, were mild and non-
vision threatening, with no significant difference between the two glaucoma types. These
findings support the Microstent's use in PXG.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.