Objective: To compare cataract surgery with implantation of a Schlemm canal microstent with cataract surgery alone for the reduction of intraocular pressure (IOP) and medication use after 24 months. Design: Prospective, multicenter, single-masked, randomized controlled trial. Participants: Subjects with concomitant primary open-angle glaucoma (POAG), visually significant cataract, and washed-out modified diurnal IOP (MDIOP) between 22 and 34 mmHg. Methods: Subjects were randomized 2:1 to receive a single Hydrus Microstent (Ivantis, Inc, Irvine, CA) in the Schlemm canal or no stent after uncomplicated phacoemulsification. Comprehensive eye examinations were conducted 1 day, 1 week, and 1, 3, 6, 12, 18, and 24 months postoperatively. Medication washout and MDIOP measurement were repeated at 12 and 24 months. Main Outcome Measures: The primary and secondary effectiveness end points were the proportion of subjects demonstrating a 20% or greater reduction in unmedicated MDIOP and change in mean MDIOP from baseline at 24 months, respectively. Hypotensive medication use was tracked throughout the course of follow-up. Safety measures included the frequency of surgical complications and adverse events. Results: A total of 369 eyes were randomized after phacoemulsification to Hydrus Microstent (HMS) and 187 to no microstent (NMS). At 24 months, unmedicated MDIOP was reduced by ≥20% in 77.3% of HMS group eyes and in 57.8% of NMS group eyes (difference = 19.5%, 95% confidence interval [CI] 11.2%–27.8%, P < 0.001). The mean reduction in 24-month unmedicated MDIOP was −7.6±4.1 mmHg (mean ± standard deviation) in the HMS group and −5.3±3.9 mmHg in the NMS group (difference = −2.3 mmHg; 95% CI, −3.0 to −1.6; P < 0.001). The mean number of medications was reduced from 1.7±0.9 at baseline to 0.3±0.8 at 24 months in the HMS group and from 1.7±0.9 to 0.7±0.9 in the NMS group (difference = −0.4 medications; P < 0.001). There were no serious ocular adverse events related to the microstent, and no significant differences in safety parameters between the 2 groups. Conclusions: This 24-month multicenter randomized controlled trial demonstrated superior reduction in MDIOP and medication use among subjects with mild-to-moderate POAG who received a Schlemm canal microstent combined with phacoemulsification compared with phacoemulsification alone.
A Schlemm Canal Microstent for Intraocular Pressure Reduction in Primary Open-Angle Glaucoma and Cataract: The HORIZON Study / Samuelson, Thomas W.; Chang, David F.; Marquis, Robert; Flowers, Brian; Lim, K. Sheng; Ahmed, Iqbal Ike K.; Jampel, Henry D.; Aung, Tin; Crandall, Alan S.; Singh, Kuldev; Walters, Tom; Marquis, Robert; Flowers, Brian; Jones, Jason; Vold, Steven D.; Smith, Stephen E.; Foster, Gary; Greene, Brennan P.; Tran, Dan B.; Ansari, Husam; Olander, Kenneth; Atodaria, Neil; Mccabe, Cathleen; Lewis, Richard; Qazi, Mujtaba; Nguyen, Quang; Meier, Edward; Godfrey, David; El Mallah, Mohammed; Levine, Jason; Johnson, C. Stark; Craven, E. Randy; Hawkins, Richard D.; Clifford, William; Singh, Inder Paul; Chu, Y. Ralph; Crandall, Alan C.; Rhee, Douglas; Lim, K. Sheng; Larrosa Poves, Jose Manuel; Rekas, Marek; Ang, Robert Edward T.; Gagne, Sebastian; Au, Leon; Dorey, Michael; Ramirez, Marina; Gandolfi, Stefano; Garcia-Feijoo, Julian; Broadway, David; Pfeiffer, Norbert. - In: OPHTHALMOLOGY. - ISSN 0161-6420. - 126:1(2019), pp. 29-37. [10.1016/j.ophtha.2018.05.012]
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