Ophthalmology · 2026
Development of Perimetric Glaucoma and Outcomes of Interventions in Pseudoexfoliation Syndrome with and without Ocular Hypertension.
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Fujita Asahi, Moradi Mousa, Shah Rishi, Elze Tobias, Zebardast Nazlee, Friedman David S
Аннотация
PURPOSE: To investigate the incidence of perimetric glaucoma and the effectiveness of interventions in eyes with pseudoexfoliation syndrome (PXF) with and without ocular hypertension (OHTN).
DESIGN: Retrospective cohort study.
PARTICIPANTS: Eyes with documented PXF between 2016 and 2023 at a tertiary referral hospital.
METHODS: We applied 2 natural-language processing models to identify patients with pseudoexfoliation and confirmed PXF status through chart review. Glaucoma incidence was defined using consecutive Humphrey visual field (HVF) tests with positive results for glaucoma labelled by PyGlaucoMetrics (https://github.com/Mousamoradi/PyGlaucoMetrics), which use validated algorithms to estimate glaucoma probability from reproducible HVF data. We estimated the cumulative incidence of perimetric glaucoma using the Kaplan-Meier method and a multivariable Cox regression model to identify factors associated with glaucoma incidence. Outcomes of procedural interventions were evaluated.
MAIN OUTCOME MEASURES: Glaucoma incidence rates.
RESULTS: Among 485 eyes from 369 patients, the 4-year cumulative incidence of perimetric glaucoma was 26.5% (95% confidence interval [CI], 20.7%-32.0%) in eyes without OHTN and 37.5% (95% CI, 24.3%-48.4%) in those with OHTN (P = 0.005, log-rank test). Factors associated with incident glaucoma were older age (hazard ratio [HR], 1.39 per 5 years [95% CI, 1.19-1.62]), OHTN (HR, 2.18 [95% CI, 1.39-3.42]), higher cup-to-disc ratio (CDR; HR, 1.17 per 0.1-higher CDR [95% CI, 1.04-1.31]), and phakia (HR, 1.94 [95% CI, 1.13-3.34]). During follow-up, incident OHTN was observed in 14.6% of eyes with PXF without baseline OHTN. However, 87.3% of eyes that demonstrated glaucoma had no documented OHTN, based on measured intraocular pressure (IOP) at any office visit. Standalone lens extraction reduced the mean ± standard deviation (SD) IOP from 15.8 ± 2.5 mmHg with 0.40 ± 0.78 medications before surgery to 12.9 ± 2.7 mmHg with 0.28 ± 0.57 medications at 1 year postoperatively.
CONCLUSIONS: More than one-fourth of eyes with documented PXF without OHTN and more than one-third of those with OHTN demonstrated perimetric glaucoma within 4 years. Older age, OHTN, higher CDR, and phakia were associated with incident glaucoma. Nearly 90% of eyes with normal baseline IOP that later demonstrated glaucoma had no documented OHTN at any office visit. Standalone lens extraction reduced IOP by 3 mmHg at 1 year postopertively.
FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
DESIGN: Retrospective cohort study.
PARTICIPANTS: Eyes with documented PXF between 2016 and 2023 at a tertiary referral hospital.
METHODS: We applied 2 natural-language processing models to identify patients with pseudoexfoliation and confirmed PXF status through chart review. Glaucoma incidence was defined using consecutive Humphrey visual field (HVF) tests with positive results for glaucoma labelled by PyGlaucoMetrics (https://github.com/Mousamoradi/PyGlaucoMetrics), which use validated algorithms to estimate glaucoma probability from reproducible HVF data. We estimated the cumulative incidence of perimetric glaucoma using the Kaplan-Meier method and a multivariable Cox regression model to identify factors associated with glaucoma incidence. Outcomes of procedural interventions were evaluated.
MAIN OUTCOME MEASURES: Glaucoma incidence rates.
RESULTS: Among 485 eyes from 369 patients, the 4-year cumulative incidence of perimetric glaucoma was 26.5% (95% confidence interval [CI], 20.7%-32.0%) in eyes without OHTN and 37.5% (95% CI, 24.3%-48.4%) in those with OHTN (P = 0.005, log-rank test). Factors associated with incident glaucoma were older age (hazard ratio [HR], 1.39 per 5 years [95% CI, 1.19-1.62]), OHTN (HR, 2.18 [95% CI, 1.39-3.42]), higher cup-to-disc ratio (CDR; HR, 1.17 per 0.1-higher CDR [95% CI, 1.04-1.31]), and phakia (HR, 1.94 [95% CI, 1.13-3.34]). During follow-up, incident OHTN was observed in 14.6% of eyes with PXF without baseline OHTN. However, 87.3% of eyes that demonstrated glaucoma had no documented OHTN, based on measured intraocular pressure (IOP) at any office visit. Standalone lens extraction reduced the mean ± standard deviation (SD) IOP from 15.8 ± 2.5 mmHg with 0.40 ± 0.78 medications before surgery to 12.9 ± 2.7 mmHg with 0.28 ± 0.57 medications at 1 year postoperatively.
CONCLUSIONS: More than one-fourth of eyes with documented PXF without OHTN and more than one-third of those with OHTN demonstrated perimetric glaucoma within 4 years. Older age, OHTN, higher CDR, and phakia were associated with incident glaucoma. Nearly 90% of eyes with normal baseline IOP that later demonstrated glaucoma had no documented OHTN at any office visit. Standalone lens extraction reduced IOP by 3 mmHg at 1 year postopertively.
FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.