Comparison of the Intraocular Pressure-Lowering Effect of Minimally Invasive Glaucoma Surgery (MIGS) iStent Inject W and Hydrus—The 12-Month Real-Life Data

<b>Background/Objectives:</b> To compare the efficacy and safety of Hydrus^® Microstent and iStent inject^® W implants, in combination with phacoemulsification, for lowering intraocular pressure (IOP) in patients with glaucoma in a real-world clinical setting. <b>Methods:</b> This retrospective, single-center study analyzed medical records of glaucoma patients who underwent either Hydrus^® Microstent or iStent inject^® W implantation combined with cataract surgery at the University Hospital Muenster, Germany. Key outcome measures included absolute and relative IOP reduction, reduction in topical antiglaucoma medication use, overall success rate, and complications. A total of 32 eyes were analyzed, 16 in each treatment group, with a 12-month follow-up. <b>Results:</b> Both groups demonstrated significant postoperative IOP reduction (Hydrus: <i>p</i> < 0.001; iStent inject^® W: <i>p</i> = 0.032). The Hydrus group achieved significantly greater relative IOP reduction compared to the iStent inject^® W group (<i>p</i> = 0.043). The Hydrus group also showed a significant reduction in daily antiglaucoma medication use (<i>p</i> = 0.002), whereas the iStent inject^® W group did not achieve statistical significance in this regard (<i>p</i> = 0.054). The overall success rate was higher in the Hydrus group (38%) than in the iStent inject^® W group (13%), though the difference was not statistically significant (<i>p</i> = 0.102). No device-related complications were observed in either group. <b>Conclusions:</b> The Hydrus^® Microstent demonstrated superior IOP reduction and a more significant reduction in the need for antiglaucoma medications compared to the iStent inject^® W in a real-world setting. These findings support the use of the Hydrus implant as an effective and safe micro-invasive glaucoma surgery (MIGS) option for patients with mild to moderate POAG. Further studies with larger patient populations and long-term follow-up are warranted to confirm the efficacy in patients with PEX and advanced glaucoma.