Lang Tracy Z, Xu Benjamin Y, Li Zhiwei, Iyengar Sreenidhi, Kesselman Carl, Ambite Jose-Luis, Bolo Kyle, Do Jiun, Wong Brandon, Daskivich Lauren P
Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles.
Information Sciences Institute, Viterbi School of Engineering, University of Southern California, Los Angeles.
JAMA Ophthalmol. 2025 Sep 18. doi: 10.1001/jamaophthalmol.2025.3162.
Pharmacologic pupillary dilation is vital for eye disease screening but is often avoided due to concerns about triggering acute angle closure (AAC), a sight-threatening ophthalmic emergency.
To assess AAC incidence after dilation and validate the use of International Classification of Diseases (ICD) codes for identifying AAC cases.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used data from a primary care-based teleretinal diabetic retinopathy screening (TDRS) program. Eligible participants were Los Angeles County Department of Health Services patients who underwent teleretinal screening by dilated fundus photography between August 23, 2013, and March 1, 2024. Potential AAC cases were identified using ICD codes for angle closure, including AAC glaucoma, primary angle-closure glaucoma, and anatomical narrow angle, within 3 months of dilation. All urgent care, emergency department, and eye clinic encounters within the next calendar day after TDRS and encounters with Current Procedural Terminology codes for iridectomy/iridotomy or lens extraction within 14 calendar days of TDRS were also identified. Manual medical record review was conducted to verify AAC cases and extract clinical information. Data were analyzed from July 2024 to June 2025.
Dilation with tropicamide, 1.0%, or tropicamide, 0.5%.
Cumulative incidence of AAC after dilation.
Of 84 008 included patients, 46 255 (55.1%) were female, and the mean (SD) age was 55.4 (10.7) years. There were a total of 168 796 dilations, with a mean (SD) of 2.01 (1.50) dilations per patient. Manual medical record review confirmed 4 AAC cases after dilation: 3 coded as AAC glaucoma and 1 as anatomical narrow angle. The AAC risk was 2.4 (95% CI, 0.05-4.69) per 100 000 dilations (0.002%) or 4.8 (95% CI, 0.10-9.43) per 100 000 patients (0.005%). All 4 AACs occurred in female patients, had narrow angles in the nonpresenting eye on gonioscopy, and presented within 1 day with AAC symptoms, including eye pain and blurry vision.
AAC risk was less than 1 in 40 000 per dilation in a high-volume TDRS program serving a diverse safety net population, supporting the overall safety of dilation in this setting. Further discussion about AAC risk as a contraindication to dilation is warranted.
药物性瞳孔散大对于眼病筛查至关重要，但由于担心引发急性闭角型青光眼（AAC）这一威胁视力的眼科急症，往往被避免使用。
评估散瞳后AAC的发生率，并验证使用国际疾病分类（ICD）编码来识别AAC病例的有效性。
设计、设置和参与者：这项回顾性队列研究使用了基于初级保健的远程视网膜糖尿病视网膜病变筛查（TDRS）项目的数据。符合条件的参与者是洛杉矶县卫生服务部的患者，他们在2013年8月23日至2024年3月1日期间通过散瞳眼底摄影进行了远程视网膜筛查。在散瞳后3个月内，使用ICD编码来识别潜在的AAC病例，包括闭角型青光眼、原发性闭角型青光眼和解剖性窄角。还识别了TDRS后下一个日历日内的所有紧急护理、急诊科和眼科诊所就诊情况，以及TDRS后14个日历日内与虹膜切除术/虹膜切开术或晶状体摘除的当前操作术语编码相关的就诊情况。进行人工病历审查以核实AAC病例并提取临床信息。数据于2024年7月至2025年6月进行分析。
使用1.0%的托吡卡胺或0.5%的托吡卡胺进行散瞳。
散瞳后AAC的累积发生率。
在纳入的84008名患者中，46255名（55.1%）为女性，平均（标准差）年龄为55.4（10.7）岁。总共进行了168796次散瞳，每位患者平均（标准差）散瞳2.01（1.50）次。人工病历审查确认散瞳后有4例AAC病例：3例编码为闭角型青光眼，1例为解剖性窄角。AAC风险为每100000次散瞳2.4（95%置信区间，0.05 - 4.69）（0.002%）或每100000名患者4.8（95%置信区间，0.10 - 9.43）（0.005%）。所有4例AAC均发生在女性患者中，前房角镜检查显示非患眼为窄角，并且在1天内出现AAC症状，包括眼痛和视力模糊。
在为多样化安全网人群服务的大容量TDRS项目中，每次散瞳后AAC风险低于四万分之一，支持在这种情况下散瞳的总体安全性。有必要进一步讨论将AAC风险作为散瞳禁忌证的问题。
