Purpose: To evaluate the efficacy, safety, risk factors for failure, and glaucoma progression of ab interno Hydrus microstent implantation with concomitant cataract surgery.

Design: Single center retrospective case series

Methods: Patients with uncontrolled glaucoma underwent Hydrus microstent implantation with concomitant cataract surgery in Toronto, Canada. Primary outcome was success defined as either (1) less classes of glaucoma medication as compared to baseline with an IOP ±1 mmHg from baseline or (2) less than or equal classes of glaucoma medication as compared to baseline with at least 2 mmHg reduction of IOP from baseline. Secondary outcomes were (1) median IOP, (2) classes of glaucoma medication, (3) BCVA, (4) visual field mean deviation, (5) complications, (6) interventions, (7) reoperations, and (8) risk of failure. Preoperative and postoperative data up to 3 years were collected.

Results: 155 eyes of 129 patients were included from the 189 eyes of 160 patients identified. Excluded eyes consist of 21 eyes that underwent solo Hydrus microstent implantation, and 13 eyes with atypical forms of glaucoma. Median decision IOP was 17.0 mmHg (IQR 14.0 – 20.0) with a median classes of glaucoma medication of 3.0 (IQR 2.0 – 3.0). Median preoperative visual field mean deviation was -5.9 dB (IQR -11.7 to -3.0). Proportional success at postoperative year 1, 2, and 3 were 0.77 (SE 0.04), 0.68 (SE 0.04), and 0.56 (SE 0.05) respectively. Median IOP and classes of glaucoma medication at 3 years postoperative, compared to baseline, were 16.0 mmHg (IQR 14.0 – 19.0, p<0.05) and 1.2 (SD 1.4, p<0.05) respectively. There was no significant difference between preoperative and postoperative visual field mean deviation done at a mean duration of 25.0 (SE 1.2) months postoperatively (p=0.31). The most common complication after postoperative month 3 was peripheral anterior synechiae (12.7%). Reoperation was undertaken in 5.2% of eyes.

Conclusion: Hydrus microstent implantation with concomitant cataract surgery provides excellent outcomes in glaucoma patients with up to 3 years postoperatively. There was a significant reduction in IOP and classes of glaucoma medication with no significant worsening of visual field mean deviation. The results are comparable to previously published controlled clinical studies.

Retrospective study: Outcomes of ab interno Hydrus microstent with concomitant cataract surgery

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