Abstract
Purpose :
Postoperative fibrosis is the main cause of traditional glaucoma surgery (trabeculectomy and glaucoma drainage implant) failure, resulting in an increase in intraocular pressure (IOP) and subsequent progression of glaucoma. In the present study, we performed a population-based data mining analysis to gain a deeper understanding of risk factors for the failure of these incisional surgeries through innovations in Big Data science.
Methods :
The University of Missouri Health Care system is one of the largest health networks in Missouri. Patient clinical data can be accessed via the i2b2 data portal. Data collection was acquired from glaucoma-related diagnostic and procedure codes from the years 2011-2016. Of the glaucoma patients analyzed, these patients were then sub-categorized into patients who had undergone surgical failure, which for the purposes of this study, was defined as patients who were forced to undergo another surgical glaucoma intervention due to inadequate IOP control within the study time period. Demographic information including race, gender, age, and smoking status was included for analysis. Other potential risk factors such as blepharitis, diabetes mellitus, hypertension, presence of crystalline or artificial lens, aphakia, uveitis, previous ocular trauma, and dry eye syndrome were also included for the purposes of this study.
Results :
We analyzed a total of 7,170 glaucoma patients. 137 out of 393 incisional glaucoma surgery patients were found to have undergone surgical failure. In this study, females appeared to have a statistically significant increase in glaucoma surgery failure over males. Furthermore, age<65, African-American race, smoking, aphakia, blepharitis, and uveitis all appear to be associated with bleb failure (P<0.01).
Conclusions :
This study successfully elucidates the role that demographic and diagnostic data analyzed in a Big Data fashion can help to identify different risk factors for glaucoma surgery failure on a massive scale.Similar to what occurs in other tissues in the body, we surmise that smoking may induce fibrosis via inflammatory cytokines and free radicals in the subconjunctival space. Our results suggest that by emphasizing smoking cessation to patients undergoing glaucoma surgery, these patients may reap both overall health benefits as well as long term IOP control without the need for further surgeries.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.