The iStent inject trabecular micro-bypass system and the Hydrus Microstent are both effective treatments for primary open-angle glaucoma (POAG), according to a study that found both devices led to significant reductions in intraocular pressure (IOP) and the number of glaucoma medications needed.
There were no significant differences in outcomes between the 2 devices, regardless of whether ab interno canaloplasty (ABiC) was performed.
In the study, 40 patients (80 eye) underwent phacoemulsification with 1 eye receiving iStent inject and the contralateral eye receiving the Hydrus implant. The patients were followed up for a period of at least 3 months. Additionally, in 58 of the eyes, the surgical procedure included ABiC.
After 12 months, the results demonstrated a significant reduction in IOP and the number of glaucoma medications in both groups. In the iStent inject group, the mean IOP decreased from 16.8 ± 3.7 to 13.6 ± 2.9 mmHg (P = 0.003), and the mean number of glaucoma medications decreased from 1.23 ± 0.97 to 0.30 ± 0.76 (P < 0.001). Similarly, in the Hydrus group, the mean IOP decreased from 18.1 ± 4.5 to 14.9 ± 3.2 mmHg (P = 0.003), and the mean number of medications decreased from 1.20 ± 1.02 to 0.39 ± 0.72 (P = 0.001).
At the 2-month follow-up, 82.6% of iStent inject eyes and 73.9% of Hydrus eyes were medication-free, compared to only 20.0% prior to the surgery in both groups (P < 0.0001 for both groups).
The study found no statistically significant differences in IOP or medication outcomes between the iStent inject and Hydrus groups, both pre- and post-operatively. This observation held true for the entire cohort and across subgroups that underwent ABiC and those that did not.
However, concerning adverse events, the iStent inject group exhibited no complications, while in the Hydrus group, 2 eyes experienced device-related issues necessitating 5 additional surgeries. These included 1 Hydrus repositioning, 1 Hydrus exchange, 1 Hydrus removal, and 2 goniotomies.
Reference
Shultz M, Chorbajian A, Zohouralen A. Comparative Effectiveness and Safety of Two Different Trabecular MIGS Devices With and Without Ab Interno Canaloplasty in Patients with Primary Open-Angle Glaucoma. Ophthalmol Ther. 2023;doi: 10.1007/s40123-023-00819-5. Epub ahead of print. PMID: 37801274.
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