{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T05:14:10Z","timestamp":1783487650047,"version":"3.55.0"},"reference-count":11,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T00:00:00Z","timestamp":1782691200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>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. Intraocular pressure (IOP), number of glaucoma medications, best-corrected visual acuity (BCVA), surgical success, postoperative complications, and subsequent glaucoma procedures were analyzed over a 60-month follow-up. 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. Mean IOP at 60 months was similar after iStent and Hydrus implantation (16.7 \u00b1 1.8 mmHg vs. 16.5 \u00b1 1.9 mmHg, respectively). The mean number of glaucoma medications decreased from 1.86 \u00b1 0.94 to 1.36 \u00b1 1.08 in the iStent group and from 1.60 \u00b1 0.72 to 0.36 \u00b1 0.49 in the Hydrus group, with significantly fewer medications required after Hydrus implantation at 60 months. Medication-free complete surgical success using the IOP \u2264 18 mmHg criterion was achieved in 20.0% of iStent-treated eyes and 63.6% of Hydrus-treated eyes. No eye underwent additional glaucoma surgery or selective laser trabeculoplasty during follow-up. Conclusions: In this prospective non-randomized comparative cohort, both procedures provided comparable long-term treated IOP control when combined with phacoemulsification. 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.<\/jats:p>","DOI":"10.3390\/jcm15135076","type":"journal-article","created":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T00:55:11Z","timestamp":1782780911000},"page":"5076","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["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"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2530-4583","authenticated-orcid":false,"given":"Joanna","family":"Jab\u0142o\u0144ska","sequence":"first","affiliation":[{"name":"Ophthalmology Department, Military Institute of Medicine\u2014National Research Institute, Szaser\u00f3w Street 128, 04-141 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katarzyna","family":"Lewczuk","sequence":"additional","affiliation":[{"name":"Ophthalmology Department, Military Institute of Medicine\u2014National Research Institute, Szaser\u00f3w Street 128, 04-141 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karolina","family":"Krix-Jachym","sequence":"additional","affiliation":[{"name":"Ophthalmology Department, Military Institute of Medicine\u2014National Research Institute, Szaser\u00f3w Street 128, 04-141 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalia","family":"B\u0142agun","sequence":"additional","affiliation":[{"name":"Ophthalmology Department, Military Institute of Medicine\u2014National Research Institute, Szaser\u00f3w Street 128, 04-141 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marek","family":"R\u0119kas","sequence":"additional","affiliation":[{"name":"Ophthalmology Department, Military Institute of Medicine\u2014National Research Institute, Szaser\u00f3w Street 128, 04-141 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"European Glaucoma Society (2021). European Glaucoma Society Terminology and Guidelines for Glaucoma, 5th Edition. Br. J. Ophthalmol., 105, 1\u2013169.","DOI":"10.1136\/bjophthalmol-2021-egsguidelines"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1583","DOI":"10.2147\/OPTH.S135316","article-title":"Micro-invasive glaucoma surgery (MIGS): A review of surgical procedures using stents","volume":"11","author":"Pillunat","year":"2017","journal-title":"Clin. Ophthalmol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1016\/j.ophtha.2010.07.007","article-title":"Randomized evaluation of the trabecular micro-bypass stent with phacoemulsification in patients with glaucoma and cataract","volume":"118","author":"Samuelson","year":"2011","journal-title":"Ophthalmology"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1016\/j.ophtha.2018.05.012","article-title":"A Schlemm Canal Microstent for Intraocular Pressure Reduction in Primary Open-Angle Glaucoma and Cataract: The HORIZON Study","volume":"126","author":"Samuelson","year":"2019","journal-title":"Ophthalmology"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Jab\u0142o\u0144ska, J., Lewczuk, K., and R\u0119kas, M.T. (2023). Comparison of Safety and Efficacy of Hydrus and iStent Combined with Phacoemulsyfication in Open Angle Glaucoma Patients: 24-Month Follow-Up. Int. J. Environ. Res. Public Health, 20.","DOI":"10.3390\/ijerph20054152"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"742","DOI":"10.1016\/j.ophtha.2022.02.021","article-title":"Long-Term Outcomes from the HORIZON Randomized Trial for a Schlemm\u2019s Canal Microstent in Combination Cataract and Glaucoma Surgery","volume":"129","author":"Ahmed","year":"2022","journal-title":"Ophthalmology"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1016\/j.ophtha.2019.04.034","article-title":"A Prospective Randomized Trial Comparing Hydrus and iStent Microinvasive Glaucoma Surgery Implants for Standalone Treatment of Open-Angle Glaucoma: The COMPARE Study","volume":"127","author":"Ahmed","year":"2020","journal-title":"Ophthalmology"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1111\/ceo.14048","article-title":"Comparative study of 2-year outcomes for Hydrus or iStent inject microinvasive glaucoma surgery implants with cataract surgery","volume":"50","author":"Holmes","year":"2022","journal-title":"Clin. Exp. Ophthalmol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1038\/s41433-019-0459-2","article-title":"Combined phacoemulsification and microinvasive glaucoma surgery in comparison to phacoemulsification alone for open angle glaucoma","volume":"34","author":"Lee","year":"2020","journal-title":"Eye"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e051496","DOI":"10.1136\/bmjopen-2021-051496","article-title":"Comparison of Hydrus and iStent microinvasive glaucoma surgery implants in combination with phacoemulsification for treatment of open-angle glaucoma: Systematic review and network meta-analysis","volume":"12","author":"Hu","year":"2022","journal-title":"BMJ Open"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1097\/IJG.0000000000000012","article-title":"A Novel Schlemm\u2019s Canal Scaffold: Histologic Observations","volume":"24","author":"Grierson","year":"2015","journal-title":"J. Glaucoma"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/13\/5076\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T04:24:42Z","timestamp":1783484682000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/13\/5076"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,29]]},"references-count":11,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["jcm15135076"],"URL":"https:\/\/doi.org\/10.3390\/jcm15135076","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,29]]}}}