Medium Term Outcome Of Combined Phaco And Hydrus Implant

Evaluation of IOP and visual outcomes in a consecutives series of combined Phaco-emulsification and Hydrus implants in patients with open angle glaucoma

Small district Hospital located in area with a predominantly Caucasian elderly population

Retrospective analysis of all patients with open angle glaucoma (including secondary glaucoma and ocular hypertension) undergoing combined phaco and Hydrus implantation between May 2021 and December 2022. Patients were operated by a single surgeon and reviewed by team members. Most patients were kept on their usual medication after surgery. Data on complications, vision and IOP were collected at 1st day, 1 month, 2 months and 12 months or the nearest date after the follow-up interval. Endothelial cell count was not available. Patients that subsequently underwent further procedures for glaucoma were excluded. The data extracted was analysed on a Filemaker database. (The presentation will contain fully updated data)

53 patients underwent combined Phaco and Hydrus (Mean age 78.7 range 56-92, 53% female). Pre-op IOP 20.7(12-29) on 2.3 meds. Two patients were excluded for having further procedures. 55% reached 6 month review: mean IOP 13.8 (8-21) on 1.8 medications, 92% had IOP of 18 or less, 82% IOP of 15 or less. 32% reached 12 month review: mean IOP 14.1 (10-18) on 2.3 medications, 100% had IOP of 18 or less, 56% IOP of 15 or less. 85% used topical meds at 6 and 12M(92% pre-op). Other than mild hyphaema in week 1 no serious complications occured. No clinical endothelial failure. At 6 month 29 patients had a vision of 6/12 or better (16 at pre-op) and 2 patients had a vision of 6/24 or worse. Only one patient with pre-existing HSK lost one Snellen line

Trabecular bypass surgery appears to be effective at lowering IOP. A mean drop of 6 mmHg was maintained at 12 months follow up.  The procedure is relatively simple (once the technique is mastered) and requires little extra surgical time. Serious complications did not occur in this cohort. Visual outcomes were as expected in this age group. The procedure was not intended to make patients drop free, but is likely to have reduced the requirement for further more invasive procedures. Only two of 53 patients required further procedures. Combined Phaco and Hydrus implant remains a viable option for patients with mild to moderate glaucoma scheduled to undergo cataract surgery