Hydrus microstent compared to selective laser trabeculoplasty in primary open angle glaucoma: One year results

Background To compare the reduction of intraocular pressure (IOP) and glaucoma medications following selective laser trabeculoplasty (SLT) versus stand-alone placement of the Hydrus microstent, a microinvasive glaucoma surgery device. Design Prospective interventional case-series. University practice. Participants 56 eyes (56 patients) with uncontrolled primary open-angle glaucoma. Methods patients received either SLT (n = 25) or Hydrus implantation (n = 31) in two centers. Patients were evaluated at baseline and 1, 7 days, 1, 3, 6, and 12 months after surgery. Main outcome measures IOP and number of glaucoma medications variations inter- and intra- groups. Results There were no significant differences at baseline between groups but the mean deviation was worse in the Hydrus group (-8.43 ± 6.84 dB, confidence limits (CL) -2.8/-3.3 versus -3.04 ± 0.65 dB, CL -6/-10.8; p < 0.001). After 12 months, there was a significant decrease in IOP and medications in the Hydrus group compared to baseline values. In the SLT group, only the decrease in IOP was significant. There was 3-fold greater reduction in medication use in the Hydrus group compared to SLT (-1.4 ± 0.97 versus -0.5 ± 1.05, p = 0.001). 47% of patients were medication free at 12 months in the Hydrus group (4% in the SLT group). No complications were recorded in the SLT group. In the Hydrus group, three patients experienced a temporary reduction of visual acuity post-operatively and two patients had post-operative IOP spikes that resolved within one week. Conclusions Both SLT and Hydrus implantation reduced IOP without serious adverse events. Hydrus implantation led to a significant and further reduction in medication dependence at 12 months