ROME — Implantation of the Hydrus microstent in combination with cataract surgery or as a stand-alone procedure is a safe, microinvasive treatment of open-angle glaucoma, according to one specialist.
“IOP reduction is significant from the first postoperative day and remains consistent over time,” Magda Rau, MD, said at OSN Italy.
In many patients with glaucoma, maximum medical therapy is still not able to control IOP and halt progressive optic nerve damage. In addition, side effects lead to poor adherence or discontinuation in some cases. Filtration surgery, on the other hand, has a high risk for complications and bleb fibrosis.
“There is a need for less invasive, lasting surgical interventions to reduce dependence on medications while controlling IOP,” Rau said.
The Hydrus (Ivantis) is a flexible, biocompatible microstent that is inserted into Schlemm’s canal, scaffolding it over 90° and ensuring access to the collector channels.
“To implant the Hydrus, it is very important to visualize the target tissue using a gonioscopic prism. The cannula of the delivery system is inserted through a clear corneal incision and guided through the trabecular meshwork until you reach the Schlemm’s canal. Then the stent is slowly released. You remove the delivery system and make sure that 1 mm of the proximal end of the stent remains visible, protruding in the anterior chamber,” Rau said.
Rau has personally implanted the Hydrus microstent in 10 eyes of eight patients, combined with cataract surgery in two eyes and as a stand-alone procedure in eight pseudophakic eyes. Mean IOP was 34.5 mm Hg at baseline, was reduced to 12.9 mm Hg at 1 day and is stable at 12.4 mm Hg after 6 months. Medications were reduced from a mean of three at baseline to one at 3 months and 6 months.
“There were no sight-threatening adverse events. Minor intraoperative bleeding occurred because you have to expand 90° of the Schlemm’s canal, but most of the bleeding stopped during the operation,” she said.
Rau was involved in the European clinical study of the CyPass (Alcon), and after the device was recalled, she had been searching for another effective MIGS technology.
“I found this with the Hydrus, which is even better, because IOP is significantly reduced already on the first postoperative day,” she said.