Efficacy of Combined Phacoemulsification and Hydrus Microstent in Open-Angle Glaucoma Versus Combined-Mechanism/Primary Angle Closure Glaucoma.

Purpose: To evaluate the pressure-lowering efficacy of cataract surgery combined with Hydrus microstent in mainly Asian eyes with combined-mechanism glaucoma (CMG) or primary angle closure glaucoma (PACG) versus open-angle glaucoma (OAG).

Patients and methods: Patients with CMG, PACG, or OAG who were treated with 1 or more glaucoma medications prior to surgery were included in the study. Medical charts were reviewed for patients with CMG, PACG, or OAG undergoing cataract-Hydrus surgery. Multilevel mixed-effects linear regression models were performed to determine the efficacy of combined surgery on intraocular pressure (IOP) and number of glaucoma medications. Mixed-effects logistic regression models were used to assess post-operative 1-year success rate (IOP ≤ 18 mmHg without glaucoma medication) and percentage of medication-free patients.

Results: The post-operative IOP and medication use were compared in CMG/PACG (n = 49) and OAG (n = 29) eyes. At 1-year follow-up, IOP decreased in CMG/PACG (14.74 to 13.21 mmHg, p = 0.004) and was unchanged in OAG (14.48 to 14.84 mmHg, p = 0.56) (difference in absolute IOPs, p=0.02). IOP was significantly lower in CMG/PACG group compared to OAG group with a coefficient of -2.1 (95% CI - 3.9 to -0.4, p=0.02). The success rates were similar (82%, CMG/PACG; 79%, OAG, p=0.80). Both groups showed significant reductions in medications (CMG/PACG, 2.33 to 0.20, p<0.001; OAG, 2.37 to 0.38, p<0.001; between groups, p=0.20). 83% of patients achieved medication-free status (OAG, 83%; CMG/PACG, 84%, p=0.92). Regarding surgical complications, there was no significant difference between OAG and CMG/PACG groups for postoperative hyphema (p=0.64) and IOP spike (p=0.29).

Conclusion: In this retrospective study, the IOP-lowering efficacy of combined cataract-Hydrus surgery in CMG/PACG patients was similar or greater than in OAG patients.