AAO Journal: Hydrus plus phaco outcomes

Glaucoma surgery is really about one thing — getting eye pressure down enough to slow damage without creating a bigger problem than the disease. That is why surgeons care about Hydrus plus phaco. It is a combined cataract-and-glaucoma procedure that tries to buy meaningful pressure control with a lighter recovery than trabeculectomy or a tube. (aao.org) The new hook here is that AAO’s Ophthalmology Journal podcast, posted May 7, 2026, walked through fresh real-world data from Dr. Thomas Johnson’s group on what actually happens when you do this in ordinary open-angle glaucoma patients. ### What is Hydrus, exactly? Hydrus is a tiny Schlemm canal scaffold — basically a microstent placed from inside the eye at the time of cataract surgery. (aao.org) The idea is simple: cataract surgery already lowers pressure a bit in some patients, and Hydrus tries to add extra outflow through the eye’s natural drainage system. That puts it in the MIGS bucket — minimally invasive glaucoma surgery — where the tradeoff is usually less pressure-lowering than traditional surgery, but less tissue disruption too. ### What was the podcast actually about? The episode was not a generic device chat. Dr. Emily Schehlein interviewed Dr. Thomas Johnson about a study titled *Clinical Outcomes of Hydrus Microstent Implantation for Open-Angle Glaucoma: Results from a Large Academic Center*, published in *Ophthalmology Glaucoma* volume 9, issue 1, pages 48–61. (aao.org) The study looked at Hydrus implanted with cataract extraction in open-angle glaucoma over as long as 4 years. ### So what do the outcomes look like? The broad picture is consistent across the newer real-world reports and the older randomized trials. Pressure comes down. Medication burden usually drops too. In one mid-term real-world series of 101 eyes, mean pre-op pressure was 21.6 mmHg on 2.18 medication classes, and after about 16 months it was 14.6 mmHg on 1.12 classes. (aaojournal.org) Reoperation stayed under 3%, and adverse events were reported in fewer than 4% of eyes. ### Does the benefit last? Turns out the durability story is one of the main reasons surgeons still care about this device. The HORIZON randomized trial showed that adding Hydrus to cataract surgery reduced medication use and improved the odds of staying medication-free, with effects that held up through 3 years. Five-year follow-up from HORIZON also supported sustained benefit versus cataract surgery alone. (aao.org) That matters because lots of glaucoma interventions look good at 6 months and much less impressive later. ### Who is the right patient? Not every cataract patient with glaucoma is a Hydrus patient. Real-world commentary from AAO’s *EyeNet* points to the sweet spot as someone with coexisting cataract, open-angle glaucoma, pressure in the high teens or low 20s, and often two or three medications already on board. (nature.com) The catch is anatomy. Small Schlemm canal or narrow trabecular real estate can make placement less attractive and can raise the risk of malposition or “cheesewiring.” ### Why not just do cataract surgery alone? Because cataract surgery alone can help, but often not enough. The whole rationale for adding a trabecular MIGS device is to get extra pressure lowering and reduce drop burden without jumping straight to filtering surgery. The AAO technology assessment on trabecular procedures combined with cataract surgery sits in that same frame — these procedures are adjuncts for selected open-angle glaucoma patients, not universal upgrades. (aaojournal.org) ### What is the practical takeaway? Basically, Hydrus plus phaco looks strongest when the goal is moderate pressure lowering, fewer medications, and a relatively gentle surgical profile. It looks weaker when the eye needs very low target pressures or when angle anatomy is unfavorable. (aao.org) That is why these outcome papers matter — they help surgeons set expectations before the patient ever gets to the OR. ### Bottom line The podcast matters less as “news” than as a reality check. Hydrus with cataract surgery is not magic, but it does seem to deliver durable, medication-sparing pressure control for the right open-angle glaucoma patient — and that is exactly the niche MIGS is supposed to fill. (aao.org 1) (aao.org 2) (aaojournal.org)