Development of Perimetric Glaucoma and Outcomes of Interventions in Pseudoexfoliation Syndrome With and Without Ocular Hypertension.

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 SUBJECTS: Eyes with documented PXF between 2016 and 2023 at a tertiary referral hospital.

Methods

We applied two natural-language processing models to identify patients with pseudoexfoliation and, through chart review, confirmed PXF status among those who had undergone a Humphrey Visual Field (HVF) test. Glaucoma incidence was defined using consecutive glaucoma-positive HVFs labelled by PyGlaucoMetrics (https://github.com/Mousamoradi/PyGlaucoMetrics), which employ 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

485 eyes from 369 patients were included. The 4-year cumulative incidence rates of perimetric glaucoma were 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 (log-rank test, P = 0.005). Factors associated with incident glaucoma were older age (HR: 1.39 [95% CI: 1.19-1.62], per 5 years), OHTN (2.18 [1.39-3.42]), higher cup-to-disc ratio (CDR, 1.17 [1.04-1.31], per 0.1 higher CDR), and phakia (1.94 [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 developed glaucoma had no documented OHTN, based on measured IOP at any office visit. Standalone lens extraction reduced the mean IOP from 15.8 ± 2.5 mmHg with 0.40 ± 0.78 medications preoperatively 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 developed 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 developed glaucoma had no documented OHTN at any office visit. Standalone lens extraction reduced IOP by 3 mmHg at 1 year postoperatively.