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The COMPARE study directly compared standalone Hydrus Microstent with two iStent trabecular bypass devices in patients with open-angle glaucoma. The prospective multicenter randomized study found that Hydrus achieved a higher rate of complete surgical success at 12 months and produced greater reduction in glaucoma medication use. More patients in the Hydrus arm were medication-free at one year, while safety profiles were broadly similar. These findings illustrate that microinvasive glaucoma surgery is not a single homogeneous category: different devices have distinct mechanisms, implantation strategies, and pressure-lowering performance. For surgeons selecting MIGS, the practical question is not simply whether a device is minimally invasive but which trabecular pathway intervention is most appropriate for the eye and the intended treatment goal. The study also supports realistic counseling that medication reduction may be a more meaningful endpoint than dramatic IOP lowering in selected earlier-stage disease. Patient expectations, angle anatomy, cataract status, baseline medication burden, and reimbursement or access considerations remain relevant when integrating MIGS into an individualized glaucoma pathway.
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The COMPARE study directly compared standalone Hydrus Microstent with two iStent trabecular bypass devices in patients with open-angle glaucoma. The prospective multicenter randomized study found that Hydrus achieved a higher rate of complete surgical success at 12 months and produced greater reduction in glaucoma medication use. More patients in the Hydrus arm were medication-free at one year, while safety profiles were broadly similar. These findings illustrate that microinvasive glaucoma surgery is not a single homogeneous category: different devices have distinct mechanisms, implantation strategies, and pressure-lowering performance. For surgeons selecting MIGS, the practical question is not simply whether a device is minimally invasive but which trabecular pathway intervention is most appropriate for the eye and the intended treatment goal. The study also supports realistic counseling that medication reduction may be a more meaningful endpoint than dramatic IOP lowering in selected earlier-stage disease. Patient expectations, angle anatomy, cataract status, baseline medication burden, and reimbursement or access considerations remain relevant when integrating MIGS into an individualized glaucoma pathway.
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