Older age, ocular hypertension predict glaucoma in eyes with PXF syndrome

Perimetric glaucoma may develop in eyes with pseudoexfoliation syndrome (PXF) with or without ocular hypertension (OHTN), suggests a recent study. Factors such as older age, OHTN, higher cup-to-disc ratio (CDR), and phakia are associated with incident glaucoma.

A total of 485 eyes from 369 patients were included in the analysis. The cumulative incidence of perimetric glaucoma at 4 years was 26.5 percent (95 percent confidence interval [CI], 20.7‒32.0) in eyes without OHTN and 37.5 percent (95 percent CI, 24.3‒48.4) in those with OHTN (p=0.005).

Older age (hazard ratio [HR], 1.39 per 5 years, 95 percent CI, 1.19‒1.62), OHTN (HR, 2.18, 95 percent CI, 1.39‒3.42), higher CDR (HR, 1.17 per 0.1-higher CDR, 95 percent CI, 1.04‒1.31), and phakia (HR, 1.94, 95 percent CI, 1.13‒3.34) significantly correlated with incident glaucoma.

During follow-up, 14.6 percent of eyes with PXF without baseline OHTN developed incident OHTN. However, 87.3 percent of eyes with glaucoma had no documented OHTN, based on measured intraocular pressure (IOP) at any office visit.

Furthermore, standalone lens extraction resulted in a decrease in mean IOP from 15.8 mm Hg with 0.40 medications before surgery to 12.9 mm Hg with 0.28 medications at 1 year postoperatively.

In this retrospective cohort study, the authors applied two natural-language processing models to identify patients with PXF between 2016 and 2023 at a tertiary referral hospital 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, which uses algorithms to estimate glaucoma probability from reproducible HVF data.

Using the Kaplan‒Meier method, the authors estimated the cumulative incidence of perimetric glaucoma. They also identified factors associated with glaucoma incidence using a multivariable Cox regression model and evaluated the outcomes of procedural interventions.