Treatment Patterns of Childhood Glaucoma in the United States: Analysis of IRISⓇ Registry (Intelligent Research in Sight)

IF 4.1 1区医学 Q1 OPHTHALMOLOGY

American Journal of Ophthalmology Pub Date : 2024-11-30 DOI:10.1016/j.ajo.2024.11.020

Asahi Fujita , Daniel M. Vu , Kanza Aziz , Ta Chen Chang , In Young Chung , Elizabeth C. Ciociola , David S. Friedman , Anagha Lokhande , Alice C. Lorch , Joan W. Miller , Prashit Parikh , Adam L. Rothman , Kasem Seresirikachorn , Tobias Elze , Nazlee Zebardast

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引用次数: 0

Abstract

PURPOSE

To investigate treatment patterns of childhood glaucoma in the United States.

DESIGN

Retrospective clinical cohort study.

SUBJECTS

Patients under 18 years of age with a diagnosis code for glaucoma between January 1, 2013, and December 31, 2020, in the IRIS^Ⓡ Registry (Intelligent Research in Sight).

METHODS

Patient demographic information and clinical characteristics were extracted. A Cox regression model was used to determine predictors of undergoing incisional glaucoma surgery.

MAIN OUTCOME MEASURES

The primary outcomes were the percentage of childhood glaucoma eyes that underwent glaucoma-related procedures and those receiving intraocular pressure (IOP)-lowering medications. Our secondary outcomes were hazard ratios (HRs) of demographic and clinical factors for undergoing incisional surgeries.

RESULTS

A total of 5017 eyes of 3069 patients were included in this study. Based on billing codes, 208 eyes (4.1%) had primary congenital glaucoma (PCG), 1911 eyes (38.1%) had juvenile open-angle glaucoma (JOAG), 999 eyes (19.9%) had glaucoma following cataract surgery (GFCS), and 1646 (32.8%) had secondary glaucoma other than GFCS. Out of 5017 eyes with childhood glaucoma, 808 eyes (16.1%) underwent glaucoma-related procedures, and 4698 eyes (93.6%) received antiglaucoma medications. Angle surgery was the most common first-recorded procedure for PCG, and tube shunt surgery for GFCS and secondary glaucoma. Laser trabeculoplasty was mainly performed for JOAG by nonglaucoma subspecialists. Factors associated with higher likelihood of incisional surgeries were PCG (vs JOAG, HR 5.40, 95% confidence interval [CI] 1.55–18.84, P = .008), increase in IOP (HR 1.06 per mmHg, CI 1.05–1.08, P < .001), and index date at age <1 year (vs ages 11–15 years, HR 6.08, CI 1.51 – 24.44, P = .011). Being cared for by a nonglaucoma subspecialist was associated with a lower likelihood of undergoing incisional surgery (HR: 0.32 (95% CI: 0.23 – 0.44, P < .001).

CONCLUSIONS

We found that 1 in 6 childhood glaucoma eyes underwent glaucoma-related procedures, and nearly all received antiglaucoma medications. The choice of first-recorded procedure differed across age and diagnosis. Type of glaucoma, baseline IOP, age, and type of treating subspecialist were predictors for undergoing incisional glaucoma surgery.

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美国儿童青光眼的治疗模式：IRIS®Registry （Intelligent Research in Sight）的分析

目的：探讨美国儿童青光眼的治疗模式。设计：回顾性临床队列研究受试者：在IRIS®注册表（Intelligent Research in Sight）中，2013年1月1日至2020年12月31日期间诊断为青光眼的18岁以下患者。方法：提取患者的人口学信息和临床特征。采用Cox回归模型确定切口青光眼手术的预测因素。主要结局指标：主要结局是接受青光眼相关手术和接受降低眼压（IOP）药物治疗的儿童青光眼的百分比。我们的次要结局是接受切口手术的人口学和临床因素的危险比（hr）。结果：本研究共纳入3069例患者5017只眼。根据账单编码，原发性先天性青光眼（PCG） 208眼（4.1%），青少年开角型青光眼（JOAG） 1911眼（38.1%），白内障术后青光眼（GFCS） 999眼（19.9%），非GFCS的继发性青光眼1646眼（32.8%）。5017只儿童青光眼患者中，808只（16.1%）接受了青光眼相关手术，4698只（93.6%）接受了抗青光眼药物治疗。角度手术是PCG最常见的首次记录手术，GFCS和继发性青光眼最常见的是管分流手术。激光小梁成形术主要由非青光眼专科医生进行。与切口手术可能性较高相关的因素有PCG（相对于JOAG， HR 5.40, 95%可信区间[CI] 1.55-18.84, p = 0.008）、IOP升高（HR 1.06 / mmHg, CI 1.05-1.08, p）。结论：我们发现每6只儿童青光眼中就有1只接受了青光眼相关手术，几乎所有患者都接受了抗青光眼药物治疗。首次记录手术的选择因年龄和诊断而异。青光眼类型、基线IOP、年龄和治疗亚专科类型是接受切口青光眼手术的预测因素。

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来源期刊

American Journal of Ophthalmology 医学-眼科学

CiteScore

9.20

自引率

7.10%

发文量

406

审稿时长

36 days

期刊介绍： The American Journal of Ophthalmology is a peer-reviewed, scientific publication that welcomes the submission of original, previously unpublished manuscripts directed to ophthalmologists and visual science specialists describing clinical investigations, clinical observations, and clinically relevant laboratory investigations. Published monthly since 1884, the full text of the American Journal of Ophthalmology and supplementary material are also presented online at www.AJO.com and on ScienceDirect. The American Journal of Ophthalmology publishes Full-Length Articles, Perspectives, Editorials, Correspondences, Books Reports and Announcements. Brief Reports and Case Reports are no longer published. We recommend submitting Brief Reports and Case Reports to our companion publication, the American Journal of Ophthalmology Case Reports. Manuscripts are accepted with the understanding that they have not been and will not be published elsewhere substantially in any format, and that there are no ethical problems with the content or data collection. Authors may be requested to produce the data upon which the manuscript is based and to answer expeditiously any questions about the manuscript or its authors.