Real-World Outcomes With Hydrus Stent

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In a real-world setting, the Hydrus Microstent (Ivantis) combined with cataract surgery proved to be a viable option for a variety of glaucoma subtypes and severities.¹ The minimally invasive glaucoma surgery (MIGS) device provided at least medium-term efficacy in reducing both IOP and medication use in patients with mild to severe glaucoma. It also slowed disease progression.

“Ours was the first real-world study to report on Hydrus outcomes beyond 24 months postoperatively, and it reinforced findings from the Horizon study,” said Paul Harasymowycz, MD, FRCSC, at the Montreal Glaucoma Institute in Montreal, Canada.

Study specifics. The findings are based on a single-surgeon consecutive case series involving 75 patients (106 eyes). Participants underwent implantation of the Hydrus with phacoemulsification between 2013 and 2021.

Nearly two-thirds of the patients had primary open-angle glaucoma (POAG). Disease severity was fairly evenly distributed between mild (30%), moderate (39%), and severe (31%). Twelve eyes had undergone previous incisional surgery, and 41 eyes had a history of selective laser trabeculoplasty (SLT). Success was defined according to the absence of specific failure criteria: 1) glaucoma reoperation; 2) SLT; and 3) IOP less than 5 mm Hg or greater than 18 mm Hg, or an increase in the number of glaucoma medications, or loss of light perception due to glaucoma.

At three years. Overall, 67% of eyes met all success criteria, with only 14% needing additional surgery. IOP decreased 26.5% following surgery, from 18.9 ± 4.8 mm Hg to 13.9 ± 2.3 mm Hg. Medication use fell by at least one drug in 71% of eyes, while 21% were medication free following Hydrus implantation (vs. 7% preoperatively). Use of carbonic anhydrase inhibitors (CAIs) declined from 18% preoperatively to 3% following surgery.

Adverse events were few and transient. Failure was associated with higher baseline IOP and preoperative use of oral CAIs. “Interestingly, severe disease [for which Hydrus is not FDA-approved] was not linked to a higher rate of failure,” Dr. Harasymowycz said. “Most importantly, we showed that this procedure can effectively slow disease progression as demonstrated by the stability of visual fields and retinal nerve fiber layer thickness.”

Clinical implications. Dr. Harasymowycz tends to choose the Hydrus over other MIGS devices for patients who have moderate POAG and coexisting cataract, have an IOP in the high teens or low 20s, and take two or three glaucoma medications. An important consideration is the size of the Schlemm canal in the affected eye. In eyes with average or small trabecular meshwork width, he said, “We avoid Hydrus implantation as there is a greater likelihood of the implant cheesewiring into the anterior chamber or the ciliary body.”

He is now conducting a multicenter study to assess the five-year real-world Hydrus outcomes. “We hope that the findings are comparable to those of the Horizon study,” he said.         

—Miriam Karmel

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1 Salimi A et al. Ophthalmol Glaucoma. 2023:6(2);137-146.

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Relevant financial disclosures: Dr. Harasymowycz—None.

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