Factors Associated with Goniotomy Outcomes in the United States: An IRIS® Registry Analysis.

PURPOSE: To identify clinical and demographic predictors of intraocular pressure (IOP)-lowering success following goniotomy in a large, generalizable cohort using the American Academy of Ophthalmology IRIS® Registry (Intelligent Research in Sight).

DESIGN

Retrospective clinical cohort study.

PARTICIPANTS

Adults who underwent goniotomy between 2013 and 2022 in the IRIS Registry (n = 48 098).

METHODS

Multivariable logistic regression and Cox proportional hazards models were used to evaluate predictors of short-term surgical success (defined as ≥20% IOP reduction without medication data) and long-term failure. Kaplan-Meier analysis assessed cumulative success rates. The mean IOP over 36 months were compared across glaucoma subtypes and disease severity.

MAIN OUTCOME MEASURES: redictors of short-term success and long-term failure; changes in mean IOP over 36 months.

RESULTS

Among the 48 098 eyes, 52% achieved short-term success by 6 months. The mean IOP decreased from baseline 16.8 mmHg to 15.06 mmHg (10.4% decrease) after phacogoniotomy (n = 31 861) and from 21.28 mmHg to 15.26 mmHg (28.3% decrease) after standalone goniotomy (n = 3776) 36 months postoperatively. Higher baseline IOP, older age, male sex, severe glaucoma, concurrent cataract surgery, pseudoexfoliation glaucoma (PXG), and low-tension glaucoma (LTG) were independently associated with higher odds of short-term success and lower risk of long-term failure (all P < 0.05). Postoperative pilocarpine use (assumed to be applicable to the surgical eye) conferred greater odds of short-term success but greater odds of long-term failure.

CONCLUSIONS

In this large national cohort, several demographic and clinical factors-including higher baseline IOP, more severe glaucoma, PXG, and LTG diagnoses-were predictive of goniotomy success. These findings suggest that goniotomy may benefit patient groups not traditionally prioritized for minimally invasive glaucoma surgery.

FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.