Surgical Outcomes and Risk Factors for Failure in Childhood Glaucoma: Analysis of the IRIS® Registry (Intelligent Research in Sight)

Abstract

Purpose: To investigate the surgical outcomes and risk factors for failure in surgeries for childhood glaucoma.

Design: Retrospective cohort study.

Participants: Patients <18 years of age of who underwent a glaucoma-related procedure between January 1, 2013, and December 31, 2019, in the IRIS® Registry (Intelligent Research in Sight).

Methods: Patient demographic information and clinical characteristics were extracted. Failure was defined as having any of the following: intraocular pressure (IOP) >21 mm Hg, IOP reduction <20% of baseline, IOP <5 mm Hg, any additional IOP-lowering procedure, loss of light perception, removal of eye or chemodenervation, or diagnosis of phthisis bulbi.

Main outcome measures: Our primary outcome was the proportion of eyes that failed for glaucoma-related surgical procedures. Secondary outcomes included the factors associated with failure.

Results: Among 2380 eyes, failure was recorded in 1081 eyes (45.4%) at a mean of 9.1 (10.4) months. Factors associated with a higher likelihood of failure were younger age (hazard ratio [HR], 1.12, 95% confidence interval [CI], 1.06-1.18, per 5 years), higher IOP on the index date (HR, 1.10, 95% CI, 1.08-1.12, per 3 mm Hg), worse visual acuity on the index date (HR, 1.33, 95% CI, 1.23-1.44, per 1 unit higher logarithm of the minimum angle of resolution), concurrent uveitis (HR, 1.41, CI, 1.16-1.71), more glaucoma medications on the index date (HR, 1.18, CI, 1.14-1.22, per 1 medication), systemic IOP-lowering medication (HR, 1.71, CI, 1.44-2.03), and complication of hyphema (HR, 13.5, CI, 5.03-36.46). Compared with ab interno angle incision surgery, iris-based surgery (HR, 2.26, CI, 1.64-3.12), iris-based laser (HR, 1.94, CI, 1.50-2.50), and trabecular/angle-based implants (HR, 3.83, CI, 2.00-7.33) were associated with higher failure rates. One or more reoperations were required in approximately 18% of the eyes. Three-year failure rates of angle surgery were 34.5% and 39.2% for primary congenital glaucoma (PCG) and juvenile open-angle glaucoma (JOAG), respectively. More poor vision eyes were aphakic, had higher medication burden, and had ocular comorbidities, than those without poor vision.

Conclusions: Surgical failure was common in approximately half of all cases. Younger age, higher IOP and worse visual acuity at index, concurrent uveitis, and more intense preceding medication were predictors for failure.

Financial disclosure(s): Proprietary or commercial disclosure may be found after the references.

Keywords: Childhood glaucoma; IRIS Registry; Risk factors; Surgery; United States.