Impact of combined Hydrus Microstent implantation and cataract surgery on diurnal intraocular pressure range: a longitudinal, retrospective study.

PURPOSE: To evaluate the impact of combined Hydrus Microstent implantation and cataract surgery on the 24-hour intraocular pressure (IOP) range in patients with open-angle glaucoma. PATIENTS AND METHODS: This retrospective, single-center study included 125 consecutive eyes of 125 patients who underwent combined Hydrus Microstent implantation and cataract surgery. Inpatient 24-hour IOP profiles (comprising daytime Goldmann applanation tonometry and nocturnal iCare rebound tonometry) from before and after surgery were analyzed. Surgical success was defined as a postoperative mean 24-hour IOP ≤ 21 mmHg with either a ≥ 20% reduction from baseline or a reduction in glaucoma medication burden. The primary outcome measures were changes in mean 24-hour IOP, maximum 24-hour IOP, and 24-hour IOP range (defined as the difference between the maximal and minimal 24-hour IOP). RESULTS: Mean preoperative 24-hour IOP of 21.0 ± 5.5 mmHg decreased to 16.5 ± 4.0 mmHg postoperatively (mean reduction: 4.5 mmHg) at a mean follow-up of 76 days (range 7-338 days; median 61 days; IQR 35-91). The 24-hour IOP range significantly decreased from 10.7 ± 6.5 mmHg to 7.7 ± 4.0 mmHg (p < 0.001), and mean maximum 24-hour IOP decreased by 6.2 ± 5.4 mmHg. The number of glaucoma medications was reduced from 2.4 ± 1.2 to 0.6 ± 1.1, with 74.4% of patients becoming medication-free. Overall surgical success was achieved in 88.0% of patients. CONCLUSION: Combined Hydrus Microstent implantation and cataract surgery significantly reduced glaucoma medication burden and effectively decreased 24-hour IOP range and pressure spikes. PRéCIS: Combined Hydrus Microstent implantation with cataract surgery reduced diurnal intraocular pressure range and pressure peaks while lowering mean intraocular pressure, indicating improved pressure stability beyond average reduction alone.