Comparative risk of glaucoma surgery in uveitis-associated versus primary open-angle glaucoma: a multicentre database study.

OBJECTIVE

To evaluate treatment patterns of newly diagnosed glaucoma among patients with uveitis compared with primary open-angle glaucoma (POAG) without uveitis, and to identify predictors of surgical intervention.

DESIGN

Retrospective cohort study using a multicentre electronic health record network.

METHODS

Adults ≥40 years with glaucoma were identified using ICD-10 codes and stratified by uveitis history within a 2-year lookback. Two phenotypes for uveitis-associated glaucoma were evaluated: (i) specific (uveitic or steroid-induced glaucoma) and (ii) sensitive (including POAG with uveitis). Cohorts were propensity score-matched (1:1) to POAG controls without uveitis. Outcomes included incidence of bleb-forming glaucoma surgeries (trabeculectomy, aqueous shunts, XEN stents), non-bleb-forming procedures (minimally invasive glaucoma surgeries, selective laser trabeculoplasty), and initiation of intraocular pressure (IOP)-lowering drops over 10 years. Cox models estimated hazard ratios (HRs) with 95% CIs.

RESULTS

In the specific phenotype (n = 7848 per cohort), uveitis-associated glaucoma was associated with greater risk of bleb-forming surgery (8.9% vs 4.1%; HR: 1.75 [95% CI: 1.56-1.96]), particularly aqueous shunts (HR: 2.95 [95% CI: 2.55-3.42]); trabeculectomy risk was lower (HR: 0.70 [95% CI: 95% 0.54-0.91]). In the sensitive phenotype (n = 13 873 each), uveitis history was associated with greater risk of bleb-forming surgery (HR: 1.76 [95% CI: 1.60-1.93]), including aqueous shunts (HR: 2.67 [95% CI: 2.38-3.00]), but lower risk of noninvasive procedures and IOP-lowering drops. Predictors of bleb-forming surgery included male sex, Hispanic ethnicity, anterior uveitis, nicotine dependence, higher body mass index, and immunomodulatory therapy use.

CONCLUSIONS

Uveitis-associated glaucoma is associated with a greater risk of bleb-forming surgery, especially aqueous shunts, highlighting the need for early identification and tailored management in this high-risk population.