Comparison of glaucoma surgery incidence and outcomes in pigmentary and primary open-angle glaucoma: IRIS® Registry analysis.

Abstract

To investigate the characteristics, surgery incidence, and outcomes of pigmentary glaucoma (PG), compared with primary open-angle glaucoma (POAG). Retrospective cohort study SUBJECTS: Eyes with PG and POAG defined by diagnosis codes (2013-2025) in the IRIS® Registry (Intelligent Research in Sight). Cumulative incidence of procedures (trabeculectomy, tube shunt surgery, minimally invasive glaucoma surgery (MIGS), laser trabeculoplasty (LTP), and cyclophotocoagulation) was estimated using the Kaplan-Meier method. Cumulative failure probability was estimated for matched eyes. Cumulative incidence of procedures in each diagnosis group. We identified 49,171 eyes with PG and 2,546,775 eyes with POAG. Compared to the POAG group, the PG group had more non-Hispanic White patients (89.2% vs 69.0%, P < 0.001). In the PG group, the percentage of severe stage was the highest in non-Hispanic Black patients (25.1%), followed by Asian (20.2%), Hispanic (19.7%), and non-Hispanic White patients (14.6%). The 4-year cumulative incidence of procedures, including LTP, was 22.2% (95% confidence interval: 21.8-22.6%) in PG and 19.5% (19.4-19.5%) in POAG (log-rank test, P < 0.001), with the highest incidence observed in the severe stage. Filtering or cyclodestructive procedures accounted for 12.8% and 10.3% of procedures in PG and POAG, respectively (P < 0.001). The cumulative probability of failure following LTP and MIGS was statistically higher in PG than in POAG (60.7% vs 58.2% and 66.7% vs 60.8% at 1 year, both P < 0.001). Combined trabeculectomy-cataract surgery had higher 1-year failure rates than standalone trabeculectomy in both PG (56.4% vs. 33.5%) and POAG (49.1% vs. 34.9%, both P < 0.001). Eyes with PG underwent glaucoma-related procedures more frequently than those with POAG, including filtering and cyclodestructive procedures. Although the proportion of Black or Asian patients among PG is relatively small compared to White patients, they are more frequently categorized as having severe disease, underscoring the need for closer monitoring and tailored management in these populations. Surgical failure was more frequent after LTP and MIGS in PG than in POAG. Combined trabeculectomy and cataract surgery had higher failure probability than standalone trabeculectomy in both the PG and POAG groups.