This article was originally published in a sponsored newsletter.

Around the same time that iStent inject W (Glaukos) came out, modifications were made to the injector for the Hydrus Microstent (Alcon). This opportunity encouraged me to perform a head-to-head analysis of the two devices, both with and without ab-interno canaloplasty. In a group of 40 patients, I used the iStent inject W in one eye and the Hydrus in the other. I then analyzed the complete data sets for safety and efficacy at the one- and two-year marks.

Both devices lowered intraocular pressure (IOP) successfully. The patients who had ab-interno canaloplasty had a greater reduction in medications compared to the group that had stenting only.

I also found a difference in safety. The Hydrus group had a couple of serious adverse events, including one suprachoroidal displacement and two stents that went in and out of Schlemm’s canal (they perforated anteriorly through the trabecular meshwork). While this can be an effective procedure, serious adverse reactions are possible and can lead to other surgeries. I recently operated on a Hydrus patients who developed angle closure, for example.

One of the significant advantages to moving to iStent infinite is the infinite number of clicks and the ability to place three stents. With these improvements, I perform fewer canaloplasties because I can access more of the trabecular meshwork. The infinite allows us to make this procedure as safe as possible for patients and still get more increasingly impressive results.

I’m now analyzing iStent infinite data, specifically on infinite patients with and without canaloplasty, comparing combination cataract and stand-alone procedures. As these devices improve, I think we’ll find that procedures continue to become safer and more efficacious.