Ab interno trabecular bypass surgery with Schlemm´s canal microstent (Hydrus) for open angle glaucoma

Area of Science:

• Ophthalmology
• Glaucoma Surgery
• Medical Devices

Background:

• Glaucoma is a primary cause of irreversible blindness globally.
• Minimally-invasive glaucoma surgeries (MIGS) are emerging treatments.
• The Hydrus microstent facilitates ab interno trabecular bypass surgery.

Purpose of the Study:

• To evaluate the efficacy and safety of the Hydrus microstent for open-angle glaucoma (OAG).
• To compare Hydrus microstent outcomes with cataract surgery alone and the iStent device.

Main Methods:

• Systematic review of randomized controlled trials (RCTs).
• Searched multiple databases including Cochrane CENTRAL, MEDLINE, and Embase.
• Included studies compared Hydrus microstent (alone or with cataract surgery) to other treatments.

Main Results:

• Hydrus microstent with cataract surgery significantly increased medication-free patients and reduced IOP compared to cataract surgery alone (moderate-certainty evidence).
• Hydrus microstent showed greater IOP reduction than iStent in short-term follow-up (moderate-certainty evidence).
• Secondary glaucoma surgery rates were lower with Hydrus; adverse events were rare but data on specific IOP targets and quality of life were limited.

Conclusions:

• Hydrus microstent combined with cataract surgery is likely effective for reducing medication dependency and IOP in mild-to-moderate OAG.
• The Hydrus microstent appears more effective than iStent for IOP lowering in OAG.
• Larger studies are recommended to confirm safety and applicability across diverse OAG patient populations.