Comparison of Hydrus and iStent microinvasive glaucoma surgery implants in combination with phacoemulsification for treatment of open-angle glaucoma: systematic review and network meta-analysis

Abstract

ObjectivesTo compare the efficacy and safety of two Schlemm’s canal-based microinvasive glaucoma surgery (MIGS) devices, the Hydrus Microstent and the iStent Trabecular Bypass combined with phacoemulsification for treatment of open-angle glaucoma.DesignSystematic review and network meta-analysis.MethodsLiterature searches were conducted on PubMed, Web of Science, Cochrane Library and ClinicalTrials.gov to identify randomised controlled trials (RCTs) assessing the Hydrus or the iStent implantation combined with phacoemulsification for treatment of open-angle glaucoma until September 2020. Risk of bias was assessed using a six-item modified Jadad scale. Effects were estimated using the intraocular pressure (IOP) reduction (IOPR), the percentage of IOPR and the proportion of medication-free patients at follow-up end. Safety was estimated using the proportions of adverse events. The network meta-analysis was conducted within a Bayesian framework using the Markov Chain Monte Carlo method in ADDIS software.ResultsSix prospective RCTs comprising 1397 patients were identified. Regarding the absolute value and the percentage of IOPR, the Hydrus and 2-iStent implantation combined with phacoemulsification were significantly more effective than phacoemulsification alone. Rank probability analysis revealed the Hydrus might be the best choice to lower IOP. There was no significant difference in the proportion of medication-free patients among groups. The Hydrus and 2-iStent implantation had a higher probability to achieve the medication-free status versus the 1-iStent implantation and phacoemulsification alone. Overall safety profiles were good for each device with the focal peripheral anterior synechiae more frequently reported in Hydrus eyes.ConclusionsThe Hydrus implantation may have a slight advantage over the 1-iStent or 2-iStent implantation in combination with phacoemulsification to treat open-angle glaucoma. Our findings might be of some uncertainty due to the limited included data. Further studies are needed to investigate whether our findings are robust, including high-quality RCTs to directly compare these MIGS devices.

Comparative Effectiveness and Safety of Two Different Trabecular MIGS Devices With and Without Ab Interno Canaloplasty in Patients with Primary Open-Angle Glaucoma

“…There is now a wide array of potential MIGS therapies with varying mechanisms of action. The majority of clinical studies investigating MIGS have focused on individual devices, with fewer studies of paired procedures or comparisons of different procedures [ 20 , 21 , 25 , 26 ]. A greater understanding of how MIGS procedures can be combined, or their comparative utility, may reveal potential [ 27 ] new treatment approaches for patients who might otherwise experience disease progression requiring invasive filtration surgery.…”

Comparing the safety and efficacy of Preserflo Microshunt implantation and trabeculectomy for glaucoma: A systematic review and meta‐analysis

“…The IOPR data were used directly if available in the original study. If not given, the IOPR was calculated from the given data with the following formulas: IOPR = IOP baseline − IOP final , SD IOPR = (Luo et al., 2023). If data were not presented as mean ± standard deviation, Hozo et al.…”

Spotlight on Schlemm’s Canal MicroStent Injection in Patients with Glaucoma

“… 44 Results of a meta-analysis of six prospective randomised clinical trials (1397 patients) concluded findings similar to the COMPARE study, with rank probability analysis revealing phacoemulsification combined with Hydrus implantation may provide better IOP control compared to implantation of one or two iStents, albeit with a higher incidence of focal PAS. 45 This analysis also determined that the implantation of Hydrus and two iStents enacted a greater probability of reaching medication-free status when compared to one iStent and standalone phacoemulsification. 45 When compared to the implantation of two iStents in ex-vivo studies, the Hydrus microstent has been suggested to provide additional benefits in reducing aqueous outflow resistance.…”

“… 45 This analysis also determined that the implantation of Hydrus and two iStents enacted a greater probability of reaching medication-free status when compared to one iStent and standalone phacoemulsification. 45 When compared to the implantation of two iStents in ex-vivo studies, the Hydrus microstent has been suggested to provide additional benefits in reducing aqueous outflow resistance. 46 In a study of 12 pairs of cadaveric eyes, Hays et al observed a greater increase in outflow facility (73% vs 34%) across a greater range of perfusion pressures (20–50 mmHg vs 40 mmHg only) with the Hydrus microstent compared to two iStents, likely due to greater collector channel access.…”