Abstract
Purpose :
The effectiveness of combining Hydrus Microstent and phacoemulsification in glaucoma management is debated, with unclear consensus on success predictors. Our retrospective study analyzes clinical variables to elucidate these predictors and their impact on surgical success and IOP regulation in glaucoma patients treated with this combination. Our findings intend to improve surgical strategies and patient selection to optimize glaucoma treatment.
Methods :
A retrospective analysis was performed on glaucoma patients treated with phacoemulsification and Hydrus Microstent, including those with prior glaucoma procedures or laser. We assessed the mean number of ocular hypotensive medications and IOP pre- and postoperatively at 12 months, and recorded complications and secondary surgical interventions (SSIs). Surgical success was the primary outcome, defined as attaining target IOP at 12-months without additional medication or procedures. Statistical analysis included a paired t-test, chi squared test, and regression modeling.
Results :
In our 273-eye cohort, 59.0% (161/273) achieved surgical successful at 12 months. Hydrus reduced IOP from 16.1 ± 4.7 to 14.3 ± 3.5 mm Hg at 12 months (11.3%, p < 0.001) and medications from 1.9 ± 1.1 to 0.95 ± 1.2 at 12 months (50%, p < 0.001). Five eyes (1.8%) received an SSI within 12 months; there were no complications. Multivariable logistic regression revealed no significant association between surgical success and age, race, glaucoma type and severity, baseline IOP and medications, prior laser trabeculoplasty, and prior surgery. However, male sex and higher baseline medications reduced the likelihood of zero medications at 12 months. Furthermore, higher baseline IOP and number of medications were significantly associated with higher IOP at 12 months. Notably, male sex, a higher number of baseline medications, and diagnosis of pigmentary glaucoma linked to increased medication usage at 12 months.
Conclusions :
Our study identified higher baseline IOP and medication load, male sex, and pseudoexfoliation glaucoma as key predictors of surgical outcomes, underscoring the importance of personalized patient selection for optimizing treatment success. This research advocates for further investigation into additional variables to refine patient selection and improve surgical strategies in glaucoma management.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.