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IOP reduction greater after cataract surgery with microstent
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Patients with primary open-angle glaucoma who received a Schlemm’s canal microstent combined with phacoemulsification demonstrated a superior reduction in IOP and medication use compared with those who received phaco alone, according to the HORIZON study.
Patients with concomitant primary open angle glaucoma, visually significant cataract and washed-out modified diurnal IOP (MDIOP) between 22 mm Hg and 34 mm Hg were included.
Patients were randomized 2:1 to receive a single Hydrus Microstent (Ivantis) in Schlemm’s canal or no stent after uncomplicated phaco.
A total of 369 eyes were randomized after phaco to Hydrus Microstent (HMS), and 187 eyes received no microstent (NMS).
Researchers found that at 24 months, unmedicated MDIOP was reduced by at least 20% in 77.3% of HMS group eyes and in 57.8% of NMS group eyes.
The mean reduction in 24-month unmedicated MDIOP was 7.6 mm Hg in the HMS group and
5.3 mm Hg in the NMS group eyes.
Mean medication use decreased from 1.7 at baseline to 0.3 at 24 months in the HMS group and from 1.7 to 0.7 in the NMS group.
Researchers found more IOP-related events reported in the cataract surgery alone group.
The overall safety was found equivalent in the two groups, with the exception of higher rates of adhesion formation in the microstent group and higher rates of IOP-related complications in the cataract surgery group.
Long-term head-to-head studies should be undertaken to better compare the safety and efficacy of Hydrus Microstent implantation with other novel MIGS procedures, they wrote. – by Abigail Sutton
Disclosures: Samuelson is a consultant to Alcon Surgical, Abbott Medical Optics, AqueSys/Allergan, Glaukos, Ivantis, Santen and Transcend Medical and has stock options at Glaukos and Ivantis. Please see the full study for remaining authors’ financial disclosures.
Perspective
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Lisa M. Young, OD, FAAO
MIGS. MIGS. MIGS. Sometimes it feels like every time you turn around it’s another article on MIGS. I may be biased, but I truly believe that there is good reason for the continued interest, as the search continues for procedures that are minimally invasive and conjunctival sparing and offer an easy postoperative course with rapid visual recovery while adequately controlling IOP.
The HORIZON Study investigated the yet-to-be-FDA-approved Hydrus Microstent (HMS), which is inserted into Schlemm’s canal to facilitate aqueous outflow. Through their research, Samuelson and colleagues found that the addition of the HMS during cataract surgery lowered IOP an additional 2.3 mm Hg when compared to cataract surgery alone.
These results show that the HMS has the potential to be what we are looking for, but it’s still too early to make that call. With the procedures that are already approved and additional options in the pipeline, there are many horses in the race, but we have yet to cross the finish line.
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