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  • Hydrus microstent shows promising efficacy at 2 years

    Cataract/Anterior Segment, Glaucoma

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    Review of: Results from the United States cohort of the HORIZON trial of a Schlemm canal microstent to reduce intraocular pressure in primary open-angle glaucoma

    Jones J, Koch D, Vold S, et al. Journal of Cataract & Refractive Surgery, September 2019

    Investigators assessed the safety and efficacy of Schlemm canal stenting in combination with cataract surgery in eyes with mild to moderate primary open-angle glaucoma (POAG).

    Study design

    This prospective, randomized clinical trial included the 331 patients from the U.S. cohort of the HORIZON trial. Inclusion criteria were a diagnosis of mild to moderate POAG, 1 to 4 glaucoma medications and an unmedicated IOP of 22 mm Hg to 34 mm Hg after medication washout. Two hundred nineteen patients were randomized to Hydrus microstent implantation at the time of cataract surgery while 112 patients were randomized to phacoemulsification alone.

    Outcomes

    At 24 months, unmedicated diurnal IOP was significantly reduced by 20% or more in 78.5% of the microstent group and 54.5% of the phacoemulsification-only group (P<0.001). In the microstent group, 78.5% of patients were medication free compared with 39.2% in the phacoemulsification group (P<0.001). Of note, there was a mild loss of endothelial cells in the microstent group at the 3-month microscopy evaluation, but this stabilized and did not worsen at the 24-month follow-up.

    Limitations

    This study was limited by its relatively short follow up time of 24 months.

    Clinical significance

    For patients with mild to moderate POAG, microstent placement at the time of cataract surgery can safely reduce IOP and glaucoma medication burden. The combination procedure had comparable visual acuity outcomes and rates of adverse ocular events to cataract surgery alone.