Patients with malignant glaucoma respond better to surgical treatment than medical therapy
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NEW ORLEANS — Patients with malignant glaucoma, or aqueous misdirection, who received surgical management were more likely to have better visual outcomes, according to a speaker at the American Academy of Ophthalmology meeting.
“The low incidence of malignant glaucoma makes it challenging to study,” Stephanie L. Cote, MD, said during a prerecorded presentation. “Most of the current literature is from case reports or small case series, and they are typically focused on a specific treatment option. Large-scale predictive studies or randomized trials have not been done.”
Cote and colleagues analyzed the IRIS Registry to identify 4,099 unique patients with malignant glaucoma between Jan. 1, 2013, and Dec. 31, 2018.
Patients were separated into three groups depending on which type of management they received: laser hyaloidotomy or transscleral cyclophotocoagulation, surgical management or medical management.
Patients in the surgical management group saw significant improvement in logMAR visual acuity from baseline at 1 year with 0.14 units of improvement (P = .001). Patients in the hyaloidotomy or transscleral cyclophotocoagulation group improved 0.11 units, while patients in the medical management group improved 0.06 units; these changes were not statistically significant.
“We found that the majority of patients are managed conservatively with medications, around 51%. However, those treated with surgical management were observed to have a more significant response to visual acuity at 1 year compared to index date when compared to the medical management group,” Cote said.
Study limitations included the possibility of inadvertent coding mistakes used to classify cases of malignant glaucoma in the IRIS Registry, Cote said.
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Cote SL. Treatment patterns for malignant glaucoma in the United States: Analysis of the IRIS Registry. Presented at: American Academy of Ophthalmology meeting; Nov. 12-15, 2021; New Orleans.
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