虹膜登记处青光眼手术前与前房角镜检查相关的因素。

Factors Associated with Gonioscopy Before Glaucoma Procedures in the IRIS Registry.

作者信息

Vu Daniel M, Gilbert Joshua B, Goldberg Eric A, Rothman Adam L, Lin Michael M, Chang Ta C, Van Tassel Sarah H, Patel Nimesh A, Zebardast Nazlee, Ross Connor J, Elze Tobias, Lorch Alice C, Miller Joan W

机构信息

Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA.

Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, FL.

出版信息

Res Sq. 2025 Jan 13:rs.3.rs-5789587. doi: 10.21203/rs.3.rs-5789587/v1.

DOI:10.21203/rs.3.rs-5789587/v1

PMID:39877086

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11774446/

Abstract

PURPOSE

To analyze nationwide pre-operative gonioscopy utilization patterns for various glaucoma surgeries and laser surgeries over time using the IRIS Registry (Intelligent Research in Sight).

DESIGN

Retrospective cohort study.

PARTICIPANTS

All adults who underwent a glaucoma surgery or laser surgery between January 1, 2014 and April 14, 2023.

METHODS

The first glaucoma procedure from the first eye of each patient was recorded as the index event and time was measured between the most recent pre-operative gonioscopy date to the index event. Baseline demographics, pre-operative clinical characteristics, glaucoma diagnosis, procedure type, and type of subspecialist performing the procedure were collected.

MAIN OUTCOME MEASURES

Primary outcomes were the percentage of patients who had gonioscopy before a glaucoma procedure (1) at any prior visit and (2) within 1 year prior to the procedure. Secondary outcomes were the baseline factors that were associated with higher gonioscopy utilization at any prior visit using multivariable logistic regression.

RESULTS

The study included 1.1 million patients (mean age 69.5±12.0 years). A majority had an in-office laser surgery (71.9%), while 16.2% had microinvasive glaucoma surgeries (MIGS), 6.5% had a trabeculectomy or tube (traditional), and 4.6% had other glaucoma surgeries. Pre-operative gonioscopy was identified in 64.7% of patients, and 85.0% of those were within 1 year of the index event.In multivariable models, Asian (OR 1.16, 95%CI 1.13-1.18, <0.001) and Black (OR 1.13, 95%CI 1.12-1.15, <0.001) racial and ethnic groups were associated with higher odds of gonioscopy compared to White groups. When compared to traditional surgery, MIGS were associated with lower utilization (OR 0.69, 95%CI 0.68-0.71, <0.001), but in-clinic laser surgeries were not (=0.231). Glaucoma subspecialists were more likely to perform pre-operative gonioscopy compared to non-glaucoma subspecialists (OR 2.65, 95%CI 2.62-2.69, <0.001).

CONCLUSIONS

Pre-operative gonioscopy use and/or coding is lower than expected, given current guidelines. Among glaucoma procedures, ab interno MIGS were associated with lower pre-operative gonioscopy utilization.

摘要

目的

利用IRIS注册中心（智能视力研究）分析不同时间内全国范围内各种青光眼手术和激光手术术前前房角镜检查的使用模式。

设计

回顾性队列研究。

参与者

2014年1月1日至2023年4月14日期间接受青光眼手术或激光手术的所有成年人。

方法

将每位患者第一眼的首次青光眼手术记录为索引事件，并测量从最近一次术前前房角镜检查日期到索引事件之间的时间。收集基线人口统计学、术前临床特征、青光眼诊断、手术类型以及进行手术的专科类型。

主要观察指标

主要结局为在青光眼手术前（1）在任何先前就诊时以及（2）在手术前1年内进行前房角镜检查的患者百分比。次要结局为使用多变量逻辑回归分析在任何先前就诊时与更高前房角镜检查使用率相关的基线因素。

结果

该研究纳入了110万患者（平均年龄69.5±12.0岁）。大多数患者接受了门诊激光手术（71.9%），而16.2%接受了微创青光眼手术（MIGS），6.5%接受了小梁切除术或引流管植入术（传统手术），4.6%接受了其他青光眼手术。64.7%的患者进行了术前前房角镜检查，其中85.0%是在索引事件发生的1年内。在多变量模型中，与白种人群体相比，亚洲（比值比1.16，95%置信区间1.13 - 1.18，<0.001）和黑人（比值比1.13，95%置信区间1.12 - 1.15，<0.001）种族和族裔群体进行前房角镜检查的几率更高。与传统手术相比，MIGS的使用率较低（比值比0.69，95%置信区间0.68 - 0.71，<0.001），但门诊激光手术则不然（比值比 = 0.231）。与非青光眼专科医生相比，青光眼专科医生更有可能进行术前前房角镜检查（比值比2.65，95%置信区间2.62 - 2.69，<0.001）。