Phaco Hydrus Vs Phaco Alone

Retrospective comparison of IOP outcomes of phaco hydrus procedures compared to standalone phaco in patients with open angle glaucoma on medical treatment. In the past various studies have shown that phaco-emulsification has an effect on IOP with a mean drop in IOP of between 2 and 4 mmHg reported. The purpose of this retrospective review was to evaluate the usefulness of trabecular bypass surgery (Hydrus) at the time of phaco-emulsification compared to phaco alone in medically reasonably well controlled glaucoma patients

Busy Glaucoma practice in a general hospital in the north of England serving a mainly Caucasian elderly population

Retrospective review of patients identified in the hospital patient database as having undergone Phaco-emulsification in 2022-2023 whilst being treated for open angle glaucoma without additional glaucoma procedures. The primary outcomes were IOP and medication pre-operatively (at time of listing), and postoperatively at 3,6 and 12 months and compared to the cohort of patients that had Phaco-Hydrus procedures during the same time period. A subgoup in the Phaco-Hydrus cohort was identified with pre-op IOPs of less than 22 mmHG which were comparable with those found in the non-Hydrus group. All patients were operated by the author, IOP measurements by a variety of observers. Success was defined as a 20% drop in IOP with or without medication

The non Hydrus group (NH) had 27 patients with a mean age 77.6 (62-91), 44% female, mean pre-op IOP of 16.6 (10-26), on an average of 2 meds. The Hydrus group (H) had 65 patients with a mean age of 78.8 (56-92), 50% female, mean pre-op IOP 20.0 (11-35); the Hydrus subgroup (HS n=40) with pre-op IOP less than 22: mean preop IOP 16.8 (10-21). All groups had 90% follow up completed by 6 months and 70-75% at 12 months. Postop IOP NH 3 month 13.7 (8-22), 6 month 14 (9-28), 12 month 14 (9-20). Postop IOP (H) 3 month 13.2 (8-22), 6 month 14.2 (8-28), 12 month 14.3 (9-20). Postop IOP (HS)  3 month 13.2 (8-22), 6 months 13.4 (8-19), 12 months 14 (9-20). Succes at 6 months NH 37%, H 70%, HS 58%. Use of meds did not change in any group (mean 2 meds)

The NH cohort saw an average drop of IOP of 2.5 mmHg sustained over a 12 month period. The Hydrus group saw a larger fall of 5.8 mmHg, but the low pre-op IOP subgroup of hydrus patients saw an only slightly larger drop of 3.2 mmHg with a succes rate of 58% vs 37% in the non Hydrus group. It is known from other studies that IOP reductions after phaco are larger when IOP is higher pre-treatment, but this study cannot answer this as patients with higher preop IOP would have been offered Hydrus. Hydrus implantation adds a modest benefit to glaucoma patients undergoing phaco even when IOP is relatively well controlled, but appears more beneficial and likely more cost-effective when pre-op IOPs are in excess of 21 mmHg.