Outcomes of Resident Performed Hydrus, iStent, and Kahook Glaucoma Procedures in a Predominantly African-American Population.

PRECIS This retrospective study characterized the efficacy and safety of three different microinvasive glaucoma surgery (MIGS) procedures in a predominantly African-American population at the Philadelphia Veterans Affairs Hospital (Hydrus, Kahook, iStent), demonstrating no significant difference in IOP and medication reduction between the three at long term follow up. PURPOSE To compare the efficacy and safety of three different microinvasive glaucoma surgery (MIGS) procedures in a predominantly African-American population. METHODS Retrospective cohort study of patients undergoing cataract extraction combined with one of three MIGS procedures (Hydrus, iStent, Kahook) at the Philadelphia Veterans Affairs Medical Center between 1/1/2015 and 11/1/2020. Analysis of variance and regression models were used to compare reduction in intraocular pressure (IOP) and medication use among three MIGS types. RESULTS 123 eyes of 112 patients were included, including 56 (45.5%) eyes for Hydrus, 40 (32.5%) eyes for iStent , and 27 (22.0%) eyes for Kahook. Adjusted mean IOP reduction was greater for Hydrus at postoperative day 1 (-4.49 vs. -1.76 for iStent and -1.69 for Kahook, P=0.05 and greater for Kahook at postoperative week 1 (-2.53 vs. +0.70 for iStent vs. -1.41 for Hydrus, P=0.02), but did not differ significantly between MIGS types at subsequent postoperative visits (all P>0.05). In multivariable analysis, MIGS type was not significantly associated with reduction in IOP or medication use at 9-12 months postoperatively. There were no significant differences in complication rates across MIGS types. CONCLUSION In this study, the difference in IOP lowering and medication reduction postoperatively between the Hydrus, iStent, and Kahook was not statistically significant after postoperative day 1. More studies are needed to evaluate outcomes of MIGS surgeries in glaucoma populations of different disease severity.