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Cohort studyJournal of clinical medicine · 2026

Five-Year Outcomes of First-Generation iStent Versus Hydrus Microstent Implantation Combined with Phacoemulsification in Patients with Open-Angle Glaucoma: A Prospective Non-Randomized Comparative Study.

Joanna Jabłońska, Katarzyna Lewczuk, Karolina Krix-Jachym … Marek Rękas

OphthalmologyCohort study

Hydrus microstent led to medication-free glaucoma control more often than iStent at 5 years

Five-Year Outcomes of First-Generation iStent Versus Hydrus Microstent Implantation Combined with Phacoemulsification in Patients with Open-Angle Glaucoma: A Prospective Non-Randomized Comparative Study.

Joanna Jabłońska … Marek Rękas

Journal of clinical medicine · 2026

Background

This study assessed the 5-year clinical outcomes of phacoemulsification combined with implantation of either the first-generation iStent Trabecular Micro-Bypass or the Hydrus Microstent in eyes with open-angle glaucoma.

Methods

In this prospective, non-randomized comparative study, 65 eyes of 65 patients underwent combined cataract and micro-invasive glaucoma surgery with either iStent or Hydrus implantation.

n = 65 eyes

Results

63.6% of Hydrus eyes vs 20.0% of iStent eyes had medication-free eye pressure control at 5 years

20%

iStent

63.6%

Hydrus

More results

At 60 months, outcome data were available for 47 eyes (72.3%), including 25 eyes in the iStent group and 22 eyes in the Hydrus group.

Baseline characteristics did not differ significantly between groups.

More results

The mean number of glaucoma medications decreased from 1.86 ± 0.94 to 1.36 ± 1.08 in the iStent group and from 1.60 ± 0.72 to 0.36 ± 0.49 in the Hydrus group, with significantly fewer medications required after Hydrus implantation at 60 months.

No eye underwent additional glaucoma surgery or selective laser trabeculoplasty during follow-up.

“

Conclusion · 1 of 2

In this prospective non-randomized comparative cohort, both procedures provided comparable long-term treated IOP control when combined with phacoemulsification.

Conclusion · 2 of 2

Hydrus implantation was associated with a greater medication-sparing effect and a higher proportion of medication-free complete surgical success at 5 years; however, these findings should be interpreted in the context of the non-randomized design and available-case follow-up.

Post

Five-Year Outcomes of First-Generation iStent Versus Hydrus Microstent Implantation Combined with Phacoemulsification in Patients with Open-Angle Glaucoma: A Prospective Non-Randomized Comparative Study.

Hydrus microstent led to medication-free glaucoma control more often than iStent at 5 years

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