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Abstract #105091 Published in IGR 23-2
Three-year outcomes of a Schlemm canal microstent (Hydrus Microstent) with concomitant phacoemulsification in open-angle glaucoma
Salimi A; Salimi A; Salimi A; Kassem R; Santhakumaran S; Harasymowycz POphthalmology. Glaucoma 2023; 6: 137-146
PURPOSE: HORIZON trials have reported the medium- and long-term outcomes of Hydrus microstent combined with cataract surgery. However, outside of randomized clinical trials, outcomes beyond 24 months have not been previously reported. Here, we examine the 3-year outcomes of Hydrus microstent with cataract surgery outside of a randomized clinical trial setting. DESIGN: Single-surgeon consecutive case series. PARTICIPANTS: Glaucomatous eyes that underwent implantation of a Hydrus microstent with concomitant cataract surgery, at a single Ophthalmology center in Montreal, Canada. METHODS: Success was defined according to the absence of specific failure criteria: A) glaucoma reoperation; B) selective laser trabeculoplasty; C) Intraocular pressure (IOP) < 5mmHg, >18 mmHg, or increase in the number of antiglaucoma medication (AGM) used (noted at ≥ 2 consecutive visits following the first postoperative month), or loss of light perception due to glaucoma; D) aggregation of criteria A-C. Predictors of treatment failure and postoperative changes in IOP and AGM use were assessed. Safety included best-corrected visual acuity (BCVA), cup-to-disc ratio (CDR), retinal nerve fiber layer (RNFL) thickness, ganglion cell inner plexiform layer (GC-IPL) thickness, visual field mean deviation (VF-MD) and pattern standard deviation (VF-PSD), and adverse events. MAIN OUTCOME MEASURES: Surgical success, predictors of treatment failure, postoperative changes in IOP and AGM use, and structural and functional markers of disease stability. RESULTS: 106 eyes with an average age of 70.2±9.7 years were included. At 3 years postoperatively, surgical success according to Criteria A to D were 86%, 83%, 91%, and 67%, respectively. IOP decreased by 26.5% from 18.9±4.8 to 13.9±2.3 mmHg (p<0.001) and AGM use reduced by 33% from 3.0±1.2 to 2.0±1.2 medications (p<0.001). The postoperative improvement in BCVA was preserved (p<0.001). The structural and functional markers of disease stability including CDR, RNFL and GC-IPL thickness, as well as VF-MD and VF-PSD remained stable (p>0.05). Postoperative adverse events were few and transient. CONCLUSION: The 36-month results from this study show that Hydrus microstent with phacoemulsification is safe and effective in reducing the IOP and AGM use among patients with mild to severe open-angle glaucoma and can slow down the disease progression by preserving both structural and functional parameters.
Department of Ophthalmology, Faculty of Medicine, McGill University, Montreal, QC, Canada; Montreal Glaucoma Institute and Bellevue Ophthalmology Clinics, Montreal, QC, Canada.
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