I have implanted the Hydrus Microstent (Ivantis) via minimally invasive glaucoma surgery (MIGS) in nearly 300 eyes over the last 4 years. Initially, I was fairly conservative. Now, I use the device in almost all cases, ranging from ocular hypertension to severe glaucoma.
Many of my patients are referred by optometrists or ophthalmologists specifically for a Hydrus Microstent because: (1) the patient does not like or cannot tolerate using antiglaucoma medications, or (2) the patient’s glaucoma is uncontrolled on maximal medical therapy. Today, I would never perform cataract surgery without implanting a Hydrus Microstent in a patient with glaucoma unless there was a specific contraindication.
Tips for a Minimal Learning Curve
I remember well my first experience implanting a Hydrus Microstent. The procedure went smoothly. The inserter that houses the microstent is easy to use and well balanced, so that the procedure feels quite natural to anterior segment surgeons.
My recommendation to surgeons just starting to implant the Hydrus Microstent is: position, position, position.
- Position the patient’s head turned away from you.
- Position your microscope by tilting it toward you.
- Position your first-attempted implantation so that if you are not successful, you can simply reposition the tip of the implanter 1 clock hour away from the first attempt. Doing so avoids having the stent pass along the area where you already performed a goniotomy.
Implanting the Hydrus Microstent is similar to cannulating a vein. You know with 100% certainty that you are in the correct location. This is one of the huge advantages of the Hydrus Microstent. Other devices can be placed in the wrong anatomical position, but with the Hydrus Microstent, the surgeon can visualize the stent for 90° along the canal of Schlemm, to be certain the stent is in the correct place.
My Happiest Patients
With modern cataract surgery, the expectation in the community is that we will deliver excellent refractive outcomes. Currently, patients who are using antiglaucoma drops expect to use them for life. This expectation can now change, as most patients with glaucoma can now expect to be drop-free after Hydrus Microstent implantation. My Hydrus Microstent patients are my happiest patients.
Importantly, unlike suprachoroidal or ab externo devices, the Hydrus Microstent does not alter the anterior chamber depth during cataract surgery. Therefore, the Hydrus Microstent does not alter the refractive outcome of your cataract surgery. A routine insertion adds minimal surgical time but enormous benefits for patients.
Key Benefits of Hydrus
No other current MIGS device has these five critical features:
- Easy to insert in the correct anatomical space and, more importantly, almost impossible to insert in the wrong anatomical space
- Safe, with minimal risk of hypotony and no risk of bleb complications1
- No increased risk of suprachoroidal hemorrhage over and above routine cataract surgery1
- Effective, with sustainability in effect even years after insertion1
- Refractively neutral
Glaucoma Practice Builder
The Hydrus Microstent is what built my glaucoma practice. I now have a waiting room full of patients with white eyes and well-controlled glaucoma. Many of my new patients have been referred by patients who have had Hydrus Microstent implantation. The Hydrus Microstent is truly revolutionary for glaucoma management.
1. Chang D. Standalone Microstent Versus 2 Trabecular Microbypass Stents for Reduction of IOP in Open Angle Glaucoma. Paper presented at: American Society of Cataract and Refractive Surgery Annual Meeting; April 18, 2018; Washington, DC.