Combined phacoemulsification and hydrus microstent for normal tension glaucoma
Reviewed by Su Young

This retrospective multicentre study followed up 77 normal tension glaucoma (NTG) eyes undergoing phacoemulsification and Hydrus implantation between 2014 and 2023 over a 36-month period. Primary outcomes were changes in intraocular pressure (IOP) and medication burden, and cumulative success probabilities from Kaplan-Meier analyses. Longitudinal changes were analysed using generalised estimating equations. Thirty-one eyes completed full 36 months of follow-up. Mean baseline IOP and medications were 13.5 ±2.5mmHg and 1.7 ±0.9, respectively. No significant reductions in IOP were observed, but a sustained reduction in medication use was observed at all follow-up timepoints (p≤0.001). At 36 months, medication use decreased by −0.7 ±0.2 (adjusted mean difference ±SE of the mean). The proportion of medication-free eyes increased from 7.8% (n=6/77) at baseline to 45.2% (n=14/31) at 36 months. When defined as a decrease in ≥1 medication from baseline without an increase in IOP, or IOP ≤15mmHg and reduced ≥20% from baseline while medication-free, and no additional laser or incisional glaucoma surgery, cumulative success was 40.7% at 36 months. No visual field mean deviation progression was detected. Adverse events were infrequent and non-sight threatening. Five (6.5%) eyes experienced postoperative hyphema, 4 (5.2%) experienced early hypotony, and 1 (1.3%) eye had a transient IOP spike of ≥30mmHg, 2 eyes (2.6%) had stent migration. Seven eyes (9.1%) required surgical revision or a secondary glaucoma procedure with PreserFlo Microshunt implantation or selective laser trabeculoplasty. 11.7% (n=9/77) of eyes developed peripheral anterior synechiae completely obstructing the Hydrus inlet. Of these, 2 eyes (2.6%, n=2/77) underwent laser iridoplasty. The authors concluded that in eyes with NTG, Phaco-Hydrus may offer a greater role in medication reduction or achieving a medication-free status over 36 months, rather than absolute IOP reduction. Clinicians can consider combined Phaco-Hydrus for glaucoma patients undergoing cataract surgery who may be intolerant of their glaucoma medication.

Thirty-six-month multicentre outcomes of combined phacoemulsification and hydrus microstent implantation in eyes with normal tension glaucoma.
Ang BCH, Betzler BK, Sim JJL, et al.
JOURNAL OF GLAUCOMA 
2026;35(6):369–76.