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The HORIZON randomized trial evaluated the Hydrus Microstent in patients with primary open-angle glaucoma undergoing cataract surgery. At five years, eyes receiving the Schlemm's canal microstent had a higher proportion of medication-free eyes with controlled intraocular pressure than eyes receiving cataract surgery alone. The Hydrus group also had a lower cumulative need for subsequent incisional glaucoma surgery, while long-term endothelial cell loss was not significantly different between groups. These findings provide meaningful support for a MIGS approach in selected patients with mild-to-moderate POAG and cataract. The important qualification is that MIGS is not equivalent to trabeculectomy for very advanced or very low-target-pressure disease. Instead, the value is greatest when modest additional pressure lowering and medication reduction are clinically meaningful. For HCPs, patient selection should include baseline IOP, disease stage, medication burden, angle anatomy and target pressure. The five-year data are particularly useful because they move beyond the short-term postoperative period and demonstrate that the benefit can persist. This fits AIOC's focus on MIGS and contemporary glaucoma surgery.
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The HORIZON randomized trial evaluated the Hydrus Microstent in patients with primary open-angle glaucoma undergoing cataract surgery. At five years, eyes receiving the Schlemm's canal microstent had a higher proportion of medication-free eyes with controlled intraocular pressure than eyes receiving cataract surgery alone. The Hydrus group also had a lower cumulative need for subsequent incisional glaucoma surgery, while long-term endothelial cell loss was not significantly different between groups. These findings provide meaningful support for a MIGS approach in selected patients with mild-to-moderate POAG and cataract. The important qualification is that MIGS is not equivalent to trabeculectomy for very advanced or very low-target-pressure disease. Instead, the value is greatest when modest additional pressure lowering and medication reduction are clinically meaningful. For HCPs, patient selection should include baseline IOP, disease stage, medication burden, angle anatomy and target pressure. The five-year data are particularly useful because they move beyond the short-term postoperative period and demonstrate that the benefit can persist. This fits AIOC's focus on MIGS and contemporary glaucoma surgery.
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