To evaluate burden of incisional glaucoma surgery (trabeculectomy and glaucoma drainage device implantation) after laser trabeculoplasty (LTP) in the United States.
Retrospective matched case-comparison study. Subjects, Participants, and/or Controls: Medicare beneficiaries who underwent LTP between January 2012 and December 2014 were identified using the 5% Medicare Current Beneficiary Survey.
Subjects aged thirty-five years of age or older at the time of LTP with ocular hypertension, glaucoma suspect, or mild open angle glaucoma (OAG) were matched to a comparison group without LTP on the basis of age, gender, race, geographic region and glaucoma diagnosis codes. Survival analysis and Cox proportional hazard analysis were performed.
Primary analysis included risk of incisional glaucoma surgery. Secondary analysis included risk of conversion to moderate or severe OAG based on billing data.
The mean age of study participants was 75.0 ± 8.9 years. After 2 years, 40 of 2,435 eyes required incisional glaucoma surgery after LTP, while 51 among 2,435 eyes required glaucoma surgery in the comparison group (p=0.30, adjusted for covariates). Regardless of intervention, African Americans were more likely to require glaucoma surgery (hazard ratio (HR) 1.89, 95% confidence interval (CI): 1.13, 3.17). Patients with a diagnosis of OAG were more likely to require surgery than glaucoma suspects (HR 2.03, 95% CI: 1.12, 3.69). African Americans and those with a diagnosis of OAG were also more likely to require surgery or convert to more severe glaucoma (HR 3.21, 95% CI: 1.92, 5.47) versus White Americans, and (HR 1.46, 95% CI: 0.81, 2.64) glaucoma suspects, respectively.
LTP did not alter the need for subsequent incisional glaucoma surgery among glaucoma suspects or patients with mild OAG. Regardless of treatment with LTP, African heritage and OAG diagnosis status were risk factors for requiring glaucoma surgery.

Copyright © 2021. Published by Elsevier Inc.