One-Year Outcomes of Hydrus Microstent Combined with Cataract Surgery: Efficacy Across Glaucoma Severity Levels

Precis: The Hydrus Microstent combined cataract surgery reduces IOP and medication use in mild-to-moderate glaucoma. For severe open-angle glaucoma, it reduces medication use while maintaining a favorable safety profile. Purpose: This study evaluates the 12-month clinical outcomes of Hydrus Microstent combined with cataract surgery in eyes with open-angle glaucoma stratified by disease severity. Methods: Retrospective, single-surgeon cohort study. Eyes with mild-to-moderate and severe glaucoma eyes undergoing Hydrus implantation combined with cataract surgery were included. Primary outcomes were complete (no medication) and qualified (with medication) success (6-21 mmHg) at one year. Secondary outcomes included IOP, number of glaucoma medications, complications, failure, and success rates for 6–18 and 6-15 mmHg IOP thresholds. Results: A total of 147 eyes from 100 patients with a median baseline IOP of 16.0 [IQR: 14.0–20.0] on 2.0 [1.0–3.0] medications were included. Complete success was achieved in 78% and qualified success in 93% of eyes, with mild-to-moderate glaucoma achieving 77% and 92%, and severe glaucoma achieving 84% and 96%, respectively. In the mild-to-moderate group, mean IOP decreased from 17.1±3.8 mmHg (SD) to 15.5±2.7 mmHg ( P <0.0003), and medications were reduced from 2.2±1.1 to 0.6±1.1 ( P <0.0001). In the severe group, mean IOP was not significantly changed, and medications were reduced from 2.6±1.3 to 1.2±1.3 ( P =0.0008). At 12 months, 64% of eyes were medication-free, and 67% of severe cases required one or fewer medications. Focal peripheral anterior synechiae (35%) was the most common complication. Conclusion: The Hydrus Microstent lowered medication use across all glaucoma severities. Further studies with larger sample sizes are warranted to support these findings.