Comparison of glaucoma surgery incidence and outcomes in pseudoexfoliation and primary open-angle glaucoma: IRIS® Registry analysis.

Purpose: To compare the incidence of glaucoma surgeries and surgical outcomes between pseudoexfoliation glaucoma (PXG) and primary open-angle glaucoma (POAG).

Design: Retrospective cohort study SUBJECTS: Patients with diagnosis codes for PXG and POAG in 2015 in the IRIS® Registry (Intelligent Research in Sight).

Methods: Baseline characteristics were balanced between patients with diagnoses of PXG and POAG using propensity score matching, and the cumulative incidence of glaucoma surgery, frequency of records of postoperative IOP spikes, and additional glaucoma surgery were compared. Among patients who underwent each type of surgery, propensity score matching was performed, and the postoperative intraocular pressure (IOP) and visual acuity (VA) were compared between groups.

Main outcome measures: The primary outcomes were the cumulative incidence rates of glaucoma surgery in each group. Secondary outcomes included postoperative IOP and VA changes and the proportion of patients experiencing postoperative IOP spikes and additional glaucoma surgery.

Results: A total of 801,253 eligible patients were identified and used to create a matched cohort of 28,196 patients from each diagnosis group. The cumulative incidence rates of glaucoma surgery at 4 years were 8.6% (95% confidence interval: 8.3-9.0%) in the POAG group and 13.6% (13.1-14.0%) in the PXG group. Filtering surgery (trabeculectomy and tube shunt surgery) accounted for 39.0% and 51.2% of the first-recorded surgery in POAG and PXG, respectively, whereas trabecular stent accounted for 44.5% and 31.3%, respectively. Significantly more patients with PXG experienced IOP spikes postoperatively than those with POAG (7.5% vs. 5.2%, P = 0.002). Additional glaucoma surgery was recorded more frequently in the PXG group than in the POAG group (10.8% vs. 7.9%, P < 0.001). The mean postoperative course of IOP and VA were similar between the two groups when the preoperative characteristics were balanced.

Conclusions: Patients with PXG were nearly twice as likely to undergo glaucoma surgery than those with POAG, even when the baseline characteristics were balanced, reflecting the more aggressive nature of PXG. Postoperatively they experienced IOP spikes and additional glaucoma surgery more frequently, underscoring the importance of close monitoring of patients with PXG.