Abstract
Purpose :
Recent work in minimally invasive glaucoma surgeries (MIGS) demonstrates the synergistic effects of combining different MIGS approaches to reduce intraocular pressure (IOP) and glaucoma medication dependency1-4. This retrospective study evaluates the outcomes of cataract surgery with Hydrus Microstent (Hydrus) alone or in conjunction with canaloplasty (Hydrus/OMNI).
Methods :
A retrospective analysis was performed on mild-to-moderate primary open angle glaucoma patients receiving microstent alone and in conjunction with canaloplasty during cataract surgery. Patients with prior glaucoma procedures or laser treatment were included. The primary outcome was surgical success, defined as attaining target IOP at one year without additional medications or procedures. The mean ocular hypotensive medications, IOP, complications, and secondary surgical interventions were recorded pre- and post-operatively at one year. Eyes were matched (1:3) based on baseline demographics, IOP, medications, and previous procedures. Paired and independent t-tests and chi-square tests were used for statistical analysis.
Results :
Of our 164-eye cohort (126 Hydrus, 36 Hydrus/OMNI), mean IOP at one year was 14.6±3.4 mmHg (7.5% reduction, p<0.05) after Hydrus alone and 14.9±4.1 mmHg (3.8% reduction, p>0.05) after Hydrus/OMNI. Mean medications at one year were 0.87±1.18 (53.6% reduction, p<0.001) after Hydrus alone and 0.71±1.33 (63.0% reduction, p<0.001) after Hydrus/OMNI. Surgical success at one year was 60.3% for Hydrus alone and 69.0% for Hydrus/OMNI (p>0.05). At one year, 56.3% of Hydrus alone and 69.0% of Hydrus/OMNI were medication-free (p>0.05). Adverse events occurred in both groups, including corneal edema, steroid response, and hyphema.
Conclusions :
Hydrus Microstent alone and in conjunction with canaloplasty during cataract surgery effectively reduced IOP and glaucoma medication dependency over one year. Although microstent with canaloplasty marginally improved surgical success and medication-free rates as compared to microstent alone, these results were not statistically significant. The occurrence of adverse events in both treatment groups highlights the importance of careful patient selection and monitoring. Larger randomized controlled trials are required to support the viability of combining MIGS procedures during cataract surgery for glaucoma management.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.