Surgical outcomes and risk factors for failure in childhood glaucoma: Analysis of the IRIS® Registry

Asahi Fujita; Daniel M Vu; Adam L Rothman; David S Friedman; Nazlee Zebardast; Ta Chen Chang; IRIS® Registry Analytic Center Consortium

doi:10.1016/j.ophtha.2025.06.017

Surgical outcomes and risk factors for failure in childhood glaucoma: Analysis of the IRIS® Registry

Ophthalmology. 2025 Jun 24:S0161-6420(25)00388-4. doi: 10.1016/j.ophtha.2025.06.017. Online ahead of print.

Authors

Asahi Fujita¹, Daniel M Vu¹, Adam L Rothman², David S Friedman¹, Nazlee Zebardast¹, Ta Chen Chang³; IRIS® Registry Analytic Center Consortium

Collaborators

IRIS® Registry Analytic Center Consortium:
Suzann Pershing⁴, Leslie Hyman⁵, Julia A Haller⁶, Aaron Y Lee⁷, Cecilia S Lee⁸, Flora Lum⁹, Joan W Miller¹, Alice Lorch¹

Affiliations

¹ Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA.
² Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA.
³ Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA. Electronic address: t.chang@med.miami.edu.
⁴ Stanford University, Palo Alto, CA, USA.
⁵ Wills Eye Hospital, Philadelphia, PA, USA.
⁶ eScience Institute, University of Washington, Seattle, WA, USA.
⁷ eScience Institute, University of Washington, Seattle, WA, USA; Department of Ophthalmology, University of Washington, Seattle, WA, USA.
⁸ Department of Ophthalmology, University of Washington, Seattle, WA, USA.
⁹ American Academy of Ophthalmology, San Francisco, CA, USA.

PMID: 40570934
DOI: 10.1016/j.ophtha.2025.06.017

Abstract

Purpose: To investigate the surgical outcomes and risk factors for failure in surgeries for childhood glaucoma.

Design: Retrospective cohort study SUBJECTS: Patients under 18 years of age who underwent glaucoma-related procedure between January 1, 2013, and December 31, 2019, in the IRIS® Registry (Intelligent Research in Sight).

Methods: Patient demographic information and clinical characteristics were extracted. Failure was defined as having any of the following: intraocular pressure (IOP) greater than 21 mmHg, IOP reduction < 20% of baseline, IOP < 5 mmHg, any additional IOP-lowering procedure, loss of light perception, removal of eye or chemodenervation, or diagnosis of phthisis bulbi.

Main outcome measures: Our primary outcome was the proportion of eyes that failed for glaucoma-related surgical procedures. Secondary outcomes included the factors associated with failure.

Results: Among 2380 eyes, failure was recorded in 1081 eyes (45.4%) at a mean of 9.1 (10.4) months. Factors associated with a higher likelihood of failure were younger age (hazard ratio (HR): 1.12, 95% confidence interval (CI): 1.06-1.18, per 5 years), higher IOP on the index date (HR: 1.10, 95% CI: 1.08-1.12, per 3mmHg), worse visual acuity on the index date (HR: 1.33, 95% CI: 1.23-1.44, per 1 unit higher logMAR), concurrent uveitis (HR: 1.41, CI: 1.16-1.71), more glaucoma medications on the index date (HR: 1.18, CI: 1.14-1.22, per 1 medication), systemic IOP-lowering medication (HR: 1.71, CI: 1.44-2.03), and complication of hyphema (HR: 13.5, CI: 5.03-36.46). Compared to ab interno angle incision surgery, iris-based surgery (HR: 2.26, CI: 1.64 -3.12), iris-based laser (HR: 1.94, CI: 1.50-2.50), and trabecular/angle-based implants (HR: 3.83, CI: 2.00-7.33) were associated with higher failure rates. One or more re-operations were required in almost 18% of the eyes. Three-year failure rates of angle surgery were 34.5% and 39.2% for PCG and JOAG, respectively. A higher proportion of eyes with poor vision eyes were aphakic, used more intense medication, and had ocular comorbidities.

Conclusions: Surgical failure was common in nearly half of all cases. Younger age, higher IOP and worse visual acuity at index, concurrent uveitis, and more intense preceding medication were predictors for failure.

Keywords: IRIS® Registry; United States; childhood glaucoma; risk factors; surgery.