Five-year outcomes of a Schlemm's canal microstent (Hydrus Microstent) with cataract surgery in open angle glaucoma: real-world results.

Objective: To report 5-year real-world outcomes of Hydrus Microstent implantation with cataract surgery (Hydrus+CS) in mild to severe open-angle glaucoma (OAG).

Design: A retrospective, consecutive case series.

Participants: OAG eyes undergoing Hydrus+CS with 5-year follow-up.

Methods: The primary outcome was surgical success using various criteria based on intraocular pressure (IOP) thresholds (≤21, ≤18, and ≤15 mm Hg), stability or reduction in antiglaucoma medication (AGM) use, and absence of secondary glaucoma surgery. Predictors of failure were analyzed using Cox proportional hazard models. Secondary outcomes included changes in IOP, AGM use, vision, and optic nerve structural measures.

Results: Sixty-four OAG eyes with a baseline IOP of 17.8 ± 4.6 mm Hg on 2.8 ± 1.1 AGMs were included. Surgical success ranged from 91% to 25%, depending on the criteria. Six eyes (9%) required secondary glaucoma surgery, and selective laser trabeculoplasty (SLT) was performed in 41% of these cases. AGM use decreased without IOP increases in 56% of eyes. Success rates for those maintaining the same or fewer AGMs at IOP thresholds of ≤21, ≤18, and ≤15 mm Hg were 75%, 70%, and 58%, respectively. For those with reduced AGM use, success rates were 61%, 58%, and 45% at the same thresholds. Predictors of failure included higher preoperative IOP (p < 0.001) and post-operative IOP spikes (p = 0.010). IOP decreased by 26%, from 17.8 mm Hg at baseline to 13.2 mm Hg at 5 years, with AGM use declining from 2.8 to 2.2 medications (p < 0.001).

Conclusions: This study provides the longest follow-up data on Hydrus+CS, confirming its safety and efficacy in mild to severe OAG.