Postoperative complications after cataract surgery with and without concurrent minimally invasive glaucoma surgery in patients with primary open angle glaucoma: a comparative risk analysis.

BACKGROUND

Primary open-angle glaucoma (POAG) is the most common form of glaucoma and a leading cause of irreversible blindness worldwide. Treatment focuses on lowering intraocular pressure (IOP), often through cataract extraction with intraocular lens implantation (CE/IOL) alone or combined with minimally invasive glaucoma surgery (MIGS). However, comparative postoperative complication risks between these approaches remain unclear.

METHODS

This retrospective cohort study utilized the TriNetX US Collaborative Network to identify all adults (ages ≥18 years) with a diagnosis of POAG who underwent CE/IOL with or without concurrent MIGS between 2006 and 2026. The cumulative postoperative incidence of hyphema, cystoid macular edema (CME), retinal detachment (RD), and endophthalmitis were evaluated at four time intervals up to 90 days postoperatively. Propensity score matching was used to balance baseline characteristics and reduce confounding. Outcomes were compared using relative risks with 95% confidence intervals, and P-values were calculated using chi-square tests.

RESULTS

After propensity score matching, each routine cataract surgery cohort (with and without MIGS) comprised 7, 998 patients. Patients undergoing CE/IOL with MIGS had a significantly higher rate of hyphema compared with patients undergoing CE/IOL alone at all reported postoperative time points, with a cumulative incidence of 1.19% versus 0.15% at 1-90 days after surgery, respectively (P<0.0001). Conversely, the cumulative incidence of CME (2.585% vs 2.376%, P = 0.3993), RD (0.215% vs 0.139%, P = 0.2566) and endophthalmitis (0.276% vs 0.15%, P = 0.0862) at 1-90 days postoperatively at 1-90 days postoperatively were not statistically different between groups. Similar associations were observed among patients undergoing routine or complex CE/IOL combined with MIGS compared with those undergoing routine or complex CE/IOL alone with respect to hyphema, CME, and RD.

CONCLUSIONS

In this large retrospective cohort study, combined CE/IOL with MIGS was associated with a significantly increased risk of postoperative hyphema, while rates of CME, RD, and endophthalmitis remained comparable to CE/IOL alone.