Abstract
Purpose :
To examine the post-operative outcomes of corticosteroid use prior to glaucoma surgery in the treatment of primary open angle glaucoma (POAG).
Methods :
A retrospective cohort study was conducted using the TriNetX (Cambridge, MA, USA) electronic health records research network to identify patients who underwent glaucoma surgery for POAG, identified by ICD-10 and CPT code. Cases were stratified into two cohorts based on history of corticosteroid therapy of any kind for up to one year preceding surgery. Cohorts were matched for age, gender, and medical comorbidities (essential hypertension, diabetes mellitus, chronic lower respiratory disease, heart failure, nicotine dependence, alcohol related disorders, and body mass index). The primary outcomes were as follows: development of secondary glaucoma, ocular hypotony, hyphema, vitreous hemorrhage, choroidal hemorrhage, retinal detachment (RD) or tear (RT), iridocyclitis, macular edema (ME), cystoid macular degeneration (CMD), cataract, strabismus, secondary corneal edema, dry eye syndrome (DES), central retinal artery occlusion (CRAO), central retinal vein occlusion (CRVO), vitreous hemorrhage (VH), and revision of the aqueous shunt. Outcomes were compared between the cohorts after propensity score matching using logistic regression and greedy nearest-neighbor matching algorithm. The risk ratio (RR) was obtained, with a p-value <0.05 being considered as significant.
Results :
A total of 6,494 eyes were included in the analysis with 3,247 cases in each of the cohorts. Cases with a history of steroid use had increased risk (p<0.05) for hypotony (RR 1.73, 95% CI 1.31-2.30), ME (RR 2.11, 95% 1.54-2.88), CMD (RR 1.88, 95% CI 1.43-2.47), choroidal hemorrhage (RR 1.79, 95% CI 1.0-3.18), cataract (RR 1.31, 95% CI 1.10-1.56), strabismus (RR 1.55, 95% CI 1.03-2.32), DES (RR 1.41, 95% CI 1.11-1.79), and need for aqueous shunt revision (RR 1.34, 95% CI 1.08-1.65). Lack of steroid use increased risk (p<0.05) for developing secondary glaucoma (RR 0.64, 95% CI 0.51-0.82). No significant difference was found in all other primary outcome measures.
Conclusions :
History of any corticosteroid use is an important consideration for post-operative complications following glaucoma surgery. Limitations of this study included lack of data indicating route of corticosteroid administration and stratification based on type of glaucoma surgery (i.e., trabeculectomy versus aqueous drainage device).
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.