Hydrus Microstent versus Triple iStent inject W combined with phacoemulsification for glaucoma management – Three Year Outcomes

The Hydrus Microstent (HM) and iStent inject W are two widely-used trans-trabecular bypass devices. Aim: To compare the efficacy and safety of the HM with triple iStent inject W (TiSW) combined with phacoemulsification, in a real-world setting. Methods: A prospective, consecutive, quasi-experimental, longitudinal study was conducted on glaucoma patients in Brisbane, Australia. Results: Of the 105 cases, 56 (53.3%) (19M:30F) were combined with the HM and 49 (46.7%) (17M:32F) were combined with the TiSW. At three years, the mean IOP reduction in the HM group was 2.6 mmHg (from 15.1 to 12.5 mmHg), while the TiSW group showed a reduction of 2.0 mmHg (from 15.2 to 13.2 mmHg). No significant difference between the two groups was observed (-0.6 mmHg, 95% CI: -2.9, 1.7). A significant reduction in the mean number of medications was observed in both groups at three years. The mean reduction was 1.3 medications in the HM group (from 2.3 to 1.0) and 1.4 medications in the TiSW group (from 2.2 to 0.8). The difference between the groups in terms of medication reduction was not statistically significant at 0.1 (95% CI: -0.6, 0.8). The intraoperative safety of both the HM and TiSW was good, with no significant complications. Conclusion: This study has shown that both HM and TiSW combined with phacoemulsification provide effective IOP and medication reduction in glaucoma patients, with up to three years of follow-up. Surgeon preference may guide device selection, with specific considerations for patients such as extremes of ocular size or anticoagulation therapy.