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Treatment patterns of childhood glaucoma in the United States: Analysis of IRIS® Registry (Intelligent Research in Sight).
American Journal of Ophthalmology ( IF 4.1 ) Pub Date : 2024-11-29 , DOI: 10.1016/j.ajo.2024.11.020
Asahi Fujita,Daniel M Vu,Kanza Aziz,Ta Chen Chang,In Young Chung,Elizabeth C Ciociola,David S Friedman,Anagha Lokhande,Alice C Lorch,Joan W Miller,Prashit Parikh,Adam L Rothman,Kasem Seresirikachorn,Tobias Elze,Nazlee Zebardast,Suzann Pershing,Leslie Hyman,Julia A Haller,Aaron Y Lee,Cecilia S Lee,Flora Lum,Joan W Miller,Alice Lorch,

PURPOSE To investigate treatment patterns of childhood glaucoma in the United States. DESIGN Retrospective clinical cohort study SUBJECTS: Patients under 18 years of age with a diagnosis code for glaucoma between January 1, 2013, and December 31, 2020, in the IRIS® Registry (Intelligent Research in Sight). METHODS Patient demographic information and clinical characteristics were extracted. A Cox regression model was used to determine predictors of undergoing incisional glaucoma surgery. MAIN OUTCOME MEASURES The primary outcomes were the percentage of childhood glaucoma eyes that underwent glaucoma-related procedures and those receiving intraocular pressure (IOP)-lowering medications. Our secondary outcomes were hazard ratios (HRs) of demographic and clinical factors for undergoing incisional surgeries. RESULTS A total of 5017 eyes of 3069 patients were included in this study. Based on billing codes, 208 eyes (4.1%) had primary congenital glaucoma (PCG), 1911 eyes (38.1%) had juvenile open-angle glaucoma (JOAG), 999 eyes (19.9%) had glaucoma following cataract surgery (GFCS), and 1646 (32.8%) had secondary glaucoma other than GFCS. Out of 5017 eyes with childhood glaucoma, 808 eyes (16.1%) underwent glaucoma-related procedures, and 4698 eyes (93.6%) received antiglaucoma medications. Angle surgery was the most common first-recorded procedure for PCG, and tube shunt surgery for GFCS and secondary glaucoma. Laser trabeculoplasty was mainly performed for JOAG by non-glaucoma subspecialists. Factors associated with higher likelihood of incisional surgeries were PCG (vs. JOAG, HR 5.40, 95% confidence interval [CI] 1.55-18.84, p = 0.008), increase in IOP (HR 1.06 per mmHg, CI 1.05-1.08, p<0.001), and index date at age < one year (vs. ages 11-15 years, HR 6.08, CI 1.51 - 24.44, p = 0.011). Being cared for by a non-glaucoma subspecialist was associated with a lower likelihood of undergoing incisional surgery (HR: 0.32 (95%CI: 0.23 - 0.44, p<0.001). CONCLUSIONS We found that 1 in 6 childhood glaucoma eyes underwent glaucoma-related procedures, and nearly all received antiglaucoma medications. The choice of first-recorded procedure differed across age and diagnosis. Type of glaucoma, baseline IOP, age, and type of treating subspecialist were predictors for undergoing incisional glaucoma surgery.

中文翻译:


美国儿童青光眼的治疗模式:IRIS® Registry 分析(Intelligent Research in Sight)。



目的 调查美国儿童青光眼的治疗模式。设计 回顾性临床队列研究对象:2013 年 1 月 1 日至 2020 年 12 月 31 日期间在 IRIS® 登记处(Intelligent Research in Sight)中诊断代码为青光眼的 18 岁以下患者。方法 提取患者人口学信息和临床特征。采用 Cox 回归模型确定接受切开性青光眼手术的预测因子。主要结局指标 主要结局是接受青光眼相关手术的儿童青光眼眼和接受降眼压 (IOP) 药物的儿童青光眼的百分比。我们的次要结局是接受切口手术的人口统计学和临床因素的风险比 (HRs)。结果 本研究共纳入 3069 例患者的 5017 只眼。根据计费代码,208 只眼 (4.1%) 患有原发性先天性青光眼 (PCG),1911 只眼 (38.1%) 患有青少年开角型青光眼 (JOAG),999 只眼 (19.9%) 患有白内障手术后青光眼 (GFCS),1646 只眼 (32.8%) 患有 GFCS 以外的继发性青光眼。在 5017 只患有儿童青光眼的眼睛中,808 只眼睛 (16.1%) 接受了青光眼相关手术,4698 只眼睛 (93.6%) 接受了抗青光眼药物治疗。房角手术是 PCG 最常见的首次记录手术,而 GFCS 和继发性青光眼的管分流手术。激光小梁成形术主要由非青光眼亚专科医生为 JOAG 进行。与切口手术可能性较高相关的因素是 PCG(vs. JOAG,HR 5.40,95% 置信区间 [CI] 1.55-18.84,p = 0.008),眼压增加(HR 1.06/mmHg,CI 1.05-1.08,p<0.001)和一年年龄 < 时的指数日期(vs. 11-15 岁,HR 6.08,CI 1。51 - 24.44,p = 0.011)。由非青光眼亚专科医生护理与接受切口手术的可能性较低相关 (HR: 0.32 (95%CI: 0.23 - 0.44, p<0.001)。结论 我们发现每 6 只儿童青光眼眼中就有 1 只接受了青光眼相关手术,几乎所有人都接受了抗青光眼药物治疗。首次记录的手术的选择因年龄和诊断而异。青光眼类型、基线眼压、年龄和治疗亚专科类型是接受切开青光眼手术的预测因素。
更新日期:2024-11-29
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