Department of Ophthalmology, Stein and Doheny Eye Institutes, University of California, Los Angeles, Los Angeles, California.
Department of Ophthalmology, Stein and Doheny Eye Institutes, University of California, Los Angeles, Los Angeles, California; Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California.
Ophthalmol Glaucoma. 2024 Nov-Dec;7(6):615-623. doi: 10.1016/j.ogla.2024.07.006. Epub 2024 Jul 19.
To examine racial and ethnic differences in the prevalence and treatment patterns for neovascular glaucoma (NVG) in at-risk individuals in the American Academy of Ophthalmology (Academy) IRIS® Registry (Intelligent Research in Sight).
Observational retrospective cohort study.
Eyes in the IRIS Registry with a retinal ischemia based on a history of proliferative diabetic retinopathy, retinal vein occlusion, and/or ocular ischemic syndrome.
Race and ethnicity was defined as Asian, Black, Hispanic/Latino, non-Hispanic White, and other/unknown. In eyes with retinal ischemia, the outcome was NVG. In eyes with NVG, outcomes included treatment of retinal ischemia with pan-retinal photocoagulation (PRP), and surgery to lower intraocular pressure (IOP) with trabeculectomy, tube shunt, and cyclophotocoagulation (CPC). Covariates included age, sex, region of residence, insurance type, smoking status, and systemic and ocular comorbidities. Cox proportional hazards regression was used to examine adjusted associations between race and ethnicity and NVG and each type of NVG treatment.
Incidence of NVG, PRP, trabeculectomy, tube shunt, CPC, and any IOP-lowering surgery.
Of 312 106 eyes with retinal ischemia, there were 5885 (1.9%) with NVG. Compared to eyes of individuals who identified as non-Hispanic White, eyes of individuals who were Black and Hispanic/Latino had higher hazards of NVG in adjusted analyses (hazards ratio [HR] = 1.28, 95% confidence interval [CI] = 1.15-1.43 [for Black]; HR = 1.32, 95% CI = 1.17-1.47 [for Hispanic/Latino]). Compared with eyes of individuals who were non-Hispanic White, there was higher hazards of trabeculectomy in eyes of individuals who were Hispanic/Latino (adjusted HR = 1.91, 95% CI = 1.08-3.39) and higher hazards of tube shunt (adjusted HR = 1.35, 95% CI = 1.07-1.69) and of any IOP-lowering surgery (adjusted HR = 1.29, 95% CI = 1.09-1.53) in eyes of individuals who were Black. There were no statistically significant differences in the hazards of PRP or CPC.
Eyes of Black and Hispanic/Latino individuals with retinal ischemia in the IRIS Registry had higher likelihood of NVG and of IOP-lowering surgery for NVG. Further study is needed to examine the medical and social factors that preclude optimal management of diabetic eye disease, in order to prevent its blinding complications.
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
在眼科研究所（IRIS）注册中心（Intelligent Research in Sight）的高危人群中，检查新生血管性青光眼（NVG）的流行率和治疗模式的种族和民族差异。
观察性回顾性队列研究。
在视网膜缺血的情况下，在 IRIS 注册中心中有基于增殖性糖尿病视网膜病变、视网膜静脉阻塞和/或眼缺血综合征病史的眼睛。
种族和民族被定义为亚洲人、黑人、西班牙裔/拉丁裔、非西班牙裔白人以及其他/未知。在视网膜缺血的情况下，结果是 NVG。在患有 NVG 的眼睛中，结果包括用全视网膜光凝（PRP）治疗视网膜缺血，以及用小梁切除术、管分流术和环光凝术（CPC）降低眼内压（IOP）的手术。协变量包括年龄、性别、居住地区、保险类型、吸烟状况以及全身和眼部合并症。Cox 比例风险回归用于检查种族和民族与 NVG 之间以及与每种 NVG 治疗之间的调整关联。
NVG、PRP、小梁切除术、管分流术、CPC 和任何眼压降低手术的发生率。
在 312 106 只患有视网膜缺血的眼中，有 5885 只（1.9%）患有 NVG。与非西班牙裔白人的眼睛相比，黑人眼睛和西班牙裔/拉丁裔眼睛在调整后的分析中，NVG 的风险更高（危险比[HR]为 1.28，95%置信区间[CI]为 1.15-1.43[黑人]；HR 为 1.32，95% CI 为 1.17-1.47[西班牙裔/拉丁裔]）。与非西班牙裔白人的眼睛相比，西班牙裔/拉丁裔眼睛接受小梁切除术的风险更高（调整后的 HR 为 1.91，95% CI 为 1.08-3.39），而接受管分流术（调整后的 HR 为 1.35，95% CI 为 1.07-1.69）和任何眼压降低手术（调整后的 HR 为 1.29，95% CI 为 1.09-1.53）的风险更高黑人的眼睛。PRP 或 CPC 的风险没有统计学上的显著差异。
IRIS 注册中心中患有视网膜缺血的黑人眼睛和西班牙裔/拉丁裔眼睛发生 NVG 和 NVG 的眼压降低手术的可能性更高。需要进一步研究以检查阻止糖尿病眼病最佳管理的医疗和社会因素，以预防其致盲并发症。
