虹膜登记处青光眼手术前前房角镜检查编码的相关因素。

Factors Associated With Gonioscopy Coding 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

From the Department of Ophthalmology (D.M.V., J.B.G., E.A.G., M.M.L., N.A.P., N.Z., C.J.R., T.E., A.C.L., J.W.M.), Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA.

出版信息

Am J Ophthalmol. 2025 Aug 7;279:253-263. doi: 10.1016/j.ajo.2025.08.001.

DOI:10.1016/j.ajo.2025.08.001

PMID:40782887

Abstract

PURPOSE

To analyze nationwide preoperative 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 preoperative gonioscopy date to the index event. Baseline demographics, preoperative clinical characteristics, glaucoma diagnosis, procedure type, and type of subspecialist performing the procedure were collected.

MAIN OUTCOME MEASURES

Primary outcome was the percentage of patients who had preoperative gonioscopy coded within 5 years of their glaucoma procedure. Secondary outcomes were the baseline factors that were associated with higher gonioscopy use 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. Preoperative gonioscopy was identified in 63.2% of patients, and 87.0% of those were within 1 year of the index event. In multivariable models, Asian (OR 1.16, 95% CI 1.13-1.18, P < .001) and Black (OR 1.12, 95% CI 1.11-1.14, P < .001) racial groups were associated with higher odds of gonioscopy compared to the White racial group. When compared to traditional surgery, MIGS were associated with lower utilization (OR 0.67, 95% CI 0.65-0.68, P < .001), but in-clinic laser surgeries were not (P = .9). Glaucoma subspecialists were more likely to perform preoperative gonioscopy compared to nonglaucoma subspecialists (OR 2.65, 95% CI 2.61-2.68, P < .001).

CONCLUSIONS

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

摘要

目的

利用IRIS注册库（智能视力研究）分析全国范围内不同青光眼手术和激光手术随时间推移的术前房角镜检查使用模式。

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

主要结局是在青光眼手术5年内进行术前房角镜检查编码的患者百分比。次要结局是使用多变量逻辑回归分析与房角镜检查使用率较高相关的基线因素。

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置管术（传统手术），4.6%接受了其他青光眼手术。63.2%的患者进行了术前房角镜检查，其中87.0%在索引事件的1年内。在多变量模型中，与白种人种族组相比，亚洲种族组（比值比[OR]1.16，95%置信区间[CI]1.13 - 1.18，P <.001）和黑种人种族组（OR 1.12，95% CI 1.11 - 1.14，P <.001）进行房角镜检查的几率更高。与传统手术相比，MIGS的使用率较低（OR 0.67，95% CI 0.65 - 0.68，P <.001），但门诊激光手术的使用率无差异（P = 0.9）。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房角镜检查（OR 2.65，95% CI 2.61 - 2.68，P <.001）。