Comparison Of Postoperative Intraocular Pressure And Other Parameters Following Iol Implantation Using Hydroimplantation And Viscoelastic Methods In Patients With Primary Open-Angle Glaucoma And Cataracts

After phacoemulsification in patients with primary open-angle glaucoma, intraocular lens (IOL) implantation was performed using two different techniques—hydroimplantation or a viscoelastic agent. This study aimed to compare postoperative outcomes between the two methods.

Single-center prospective comparative study 

Twenty-eight patients with primary open-angle glaucoma who underwent cataract surgery during follow-up were included. IOL implantation was randomly performed using either a viscoelastic agent or balanced salt solution (hydroimplantation). Because patients with glaucoma are more susceptible to intraocular pressure (IOP) fluctuations than healthy individuals, IOP was measured at 6 hours, 1 day, and 1 month postoperatively and compared with the 1-month values. Patients who underwent hydroimplantation were assigned to Group 1, and those who underwent viscoelastic implantation were assigned to Group 2. All surgeries were performed by one surgeon (or the same surgical team) using the same phaco platform, incision size, and IOL model.

Mean age was 72±6 (Group 1) and 73±5 (Group 2; p=0.44). Preop BCVA (logMAR) was 0.85±0.49 vs 0.85±0.44; 1-month BCVA 0.13±0.24 vs 0.30±0.38 (p=0.49). IOP (mmHg) preop 17.83±5.76 vs 13.27±6.38; 6 h 22.11±9.54 vs 20.66±6.95; day 1 20.22±8.49 vs 16.44±5.27; 1 month 14.83±8.49 vs 14.88±5.62 (no between-group differences; p=0.08/0.56/0.24/0.39). Endothelial cells were 2668±359 vs 2388±261 preop and 2479±463 vs 1777±611 at 1 month; loss was lower in Group 1 (p=0.03). CCT: 545±30 vs 563±44 preop; 570±46 vs 599±63 at 1 month (p=0.37). SE: 0.53±3.31 vs −1.06±5.10 preop; 0.06±0.91 vs 0.68±0.65 at 1 month (p=0.97, 0.28). RNFL showed no significant difference; surgical time 13.67±3.08 vs 17.16±15.22 s. (p>0.05)

In patients with primary open-angle glaucoma, hydroimplantation after phacoemulsification was not superior to viscoelastic IOL implantation for 6-hour postoperative IOP change, visual acuity, spherical equivalent, or RNFL thickness. However, hydroimplantation was associated with less endothelial cell loss. This may reflect less exposure to viscoelastic material and fewer intraocular steps, as residual viscoelastic may require additional irrigation/aspiration that can stress the cornea. This effect may be more relevant in glaucoma eyes, and the lower baseline endothelial cell count in Group 2 may also have contributed.