Factors Associated With Glaucomatous Progression in Eyes With Prior Refractive Corneal Surgery

Glaucomatous patients with longer axial length and thinner central cornea have a higher risk of progression after refractive surgery, emphasizing the need for close monitoring for early detection and timely intervention.

To identify risk factors associated with glaucomatous progression in eyes with a history of refractive corneal surgery (RCS).

This retrospective observational cohort study included 65 eyes of 65 patients with primary open angle glaucoma (POAG) who underwent RCS. Glaucoma progression was determined based on structural changes in optic disc/retinal nerve fiber layer (RNFL) photographs and/or visual field (VF) deterioration. Cox proportional hazards analysis was used to identify risk factors for disease progression. VF mean deviation (MD) and RNFL thickness progression rates obtained using a linear mixed-effects model were compared across tertile groups based on axial length (AXL) and central corneal thickness (CCT), respectively.

Over the follow-up period (mean: 9.1±2.9 y), 23 eyes (35%) exhibited glaucomatous progression. The progression group had significantly longer AXL ( P <0.001), thinner CCT ( P =0.009) compared with those in the stable group. Multivariate analysis identified longer AXL [hazard ratio (HR): 1.507, P =0.037] and thinner CCT (HR: 0.988, P =0.037) as significant predictors of glaucoma progression. VF MD declined faster in the middle and highest AXL tertile groups, whereas RNFL thinning was the most pronounced in the highest AXL tertile group. The lowest CCT tertile group exhibited the fastest VF MD decline and RNFL thinning.

Patients with POAG and a history of RCS who present with longer axial length and thinner central corneal thickness, are at significantly higher risk of glaucomatous progression, highlighting the importance of vigilant long-term monitoring in these eyes.