Ashish Agar1,2, Andrew White3, Colin Clement2, Ridia Lim2

Purpose: Although MIGS aqueous shunts offer new surgical options for glaucoma, the majority of proce- dures are adjunctive to cataract surgery. Theoretically their use as solo operations would be more important in managing IOP. We studied the use of the Hydrus Microstent (Ivantis, Inc.) as a standalone glaucoma operation by several surgeons in a ‘real world’ (unrestricted surgeon discretion and no exclusion) audit of procedures and outcomes up to 3 years.
Methods: Prospective assessment of all consecutive cases of standalone MIGS with this device by partici- pating surgeons in the Sydney Multi-centre Hydrus study. Data collected by review of medical records, operative notes and post-operative ocular examina- tions. Study centres included university teaching hos- pitals and ophthalmic day surgeries. All participating surgeons were fellowship trained glaucoma specialists. Results: A total of 42 eyes were treated from 2014 to the present; POAG 85%, PXFG 8% and other 7%. Hydrus implantation was in pseudophakic (75%) and phakic patients (25%), with one unsuccessful implantation and no significant device related com- plications. A cohort of 24 patients reached 24 months follow-up; average pre-op IOP 23 mmHg on 3.3 meds and post-op 16 mmHg on 2.2 meds. Ten patients reached 36 months; average pre-op IOP 24 mmHg on
3.8 meds and post-op 15 mmHg on 2.8 meds. Conclusion: The Hydrus Microstent reduced aver- age IOP at 24 months (30%) and 36 months (38%), and average meds at 24 months (36%) and 36 months (26%). The procedure was safe and ver- satile as a standalone operation, without the need for concurrent cataract surgery.