Elevated Intraocular Pressure Immediately after Cataract Surgery and Future Risk of Primary Open-Angle Glaucoma in the IRIS® Registry (Intelligent Research in Sight)

IF 3.2 Q1 OPHTHALMOLOGY

Ophthalmology science Pub Date : 2025-06-11 DOI:10.1016/j.xops.2025.100851

Nayoon Gim BS , Yu Jiang PhD , Yelena Bagdasarova PhD , Alina Ferguson BS , Marian Blazes MD , Aaron Y. Lee MD, MSCI , Andrew Chen MD , Cecilia S. Lee MD, MS , Parisa Taravati MD , IRIS® Registry Analytic Center Consortium

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Abstract

Objective

This study evaluated associations between postoperative intraocular pressure (IOP) after cataract surgery and the future risk of developing primary open-angle glaucoma (POAG) in patients without prior glaucoma, glaucoma suspect, or ocular hypertension diagnoses.

Design

Retrospective cohort study.

Subjects

1 912 101 individuals without prior glaucoma, glaucoma suspect, or ocular hypertension diagnoses who underwent their first cataract surgery in the American Academy of Ophthalmology IRIS® Registry (Intelligent Research in Sight).

Methods

The highest IOP recorded on postoperative days 0 to 2 was used for analysis. For Kaplan–Meier survival estimates and Cox proportional hazards model analysis, IOP was dichotomized into normal (≤21 mmHg) and high (>21 mmHg) and assessed for associations with POAG. The stratified Cox model quantified the associations between IOP and the risk of POAG across different demographic groups. Additionally, postoperative IOP was divided into decile categories, and hazard ratios (HRs) of the risk of POAG were estimated for each, with the 40% to 60% IOP range as the reference, adjusting for demographic factors.

Main Outcome Measures

Cumulative probability of POAG diagnosis and HRs for POAG development.

Results

The median time to development of POAG was 682 days (interquartile range 191–1467 days). Kaplan–Meier estimates showed that the 4000-day cumulative probability of POAG diagnosis for the high IOP group was nearly double the normal group (3.4% vs. 1.7%, P < 0.0001). The Cox proportional hazards model identified high postoperative IOP, older age, male sex, and Asian, Black, Native Hawaiian, and Other Pacific Islander races, as well as Hispanic ethnicity, as risk factors for POAG. In the stratified Cox analysis, high postoperative IOP was consistently associated with increased risk of POAG across demographic subgroups. The highest IOP decile was associated with increased risk of POAG (HR 2.42; 95% confidence intervals [CI] 2.26–2.58), while the lowest decile was not (HR 0.88, 95% CI 0.81–0.95). Similar trends were observed with risks of other types of glaucoma.

Conclusions

Elevated postoperative IOP after cataract surgery is a risk factor for future POAG development, independent of age, sex, race, and ethnicity.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

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IRIS®注册表（视力智能研究）：白内障术后即刻眼压升高与原发性开角型青光眼的未来风险

目的：本研究评估无青光眼、疑似青光眼或高眼压诊断的白内障术后眼压（IOP）与原发性开角型青光眼（POAG）风险的关系。设计回顾性队列研究。研究对象：在美国眼科学会IRIS®注册中心（视力智能研究中心）接受首次白内障手术的101例既往无青光眼、疑似青光眼或高眼压诊断的患者。方法采用术后第0 ~ 2天最高眼压进行分析。对于Kaplan-Meier生存估计和Cox比例风险模型分析，将IOP分为正常（≤21 mmHg）和高（≤21 mmHg），并评估其与POAG的相关性。分层Cox模型量化了不同人群IOP与POAG风险之间的关系。此外，将术后IOP分为十分位数类别，并以40%至60% IOP范围为参考，根据人口统计学因素进行调整，估计每个类别POAG风险的危险比（hr）。主要观察指标POAG诊断的累积概率和POAG发展的hr。结果POAG发生的中位时间为682天（四分位数差为191 ~ 1467天）。Kaplan-Meier估计显示，高IOP组4000天POAG诊断的累积概率几乎是正常组的两倍(3.4% vs. 1.7%, P <；0.0001)。Cox比例风险模型确定术后IOP高、年龄较大、男性、亚洲人、黑人、夏威夷原住民和其他太平洋岛民种族以及西班牙裔是POAG的危险因素。在分层Cox分析中，高术后IOP始终与POAG风险增加相关。眼压最高的十分位数与POAG的风险增加相关(HR 2.42；95%可信区间[CI] 2.26-2.58)，而最低十分位数没有（HR 0.88, 95% CI 0.81-0.95）。其他类型青光眼的风险也有类似的趋势。结论白内障术后IOP升高是未来POAG发生的危险因素，与年龄、性别、种族和民族无关。财务披露专有或商业披露可在本文末尾的脚注和披露中找到。

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