Geriatric Assessment and Risk Prediction of Severe Complications in Glaucoma Surgery

Geriatric assessment scores, including Mini-Cog, G8, and age-adjusted Charlson Comorbidity Index, improve the prediction of severe hemorrhagic complications after glaucoma surgery, enabling more individualized risk stratification in glaucoma patients.

To investigate the associations between various postoperative complications and background factors-including geriatric assessment (GA) scores-and to evaluate the predictive value of GA-based risk stratification for severe hemorrhagic complications following glaucoma surgery.

Retrospective observational case series. A total of 729 eyes from 464 Japanese patients (mean age±SD, 70.2±12.4 y) who underwent glaucoma surgery with perioperative GA assessment at Shimane University Hospital. Geriatric assessments, including Mini-Cog, G8, and age-adjusted Charlson Comorbidity Index (ACCI), were conducted preoperatively. Surgical complications and interventions were comprehensively collected and analyzed in relation to multiple background factors using both univariate and multivariate statistical models. Predictive performance for severe hemorrhagic complications (vitreous hemorrhage and hemorrhagic choroidal detachment) was assessed via machine learning algorithms.

Postoperative complications occurred in 37% of eyes, with 8% experiencing severe hemorrhagic complications. Multivariate analysis identified low Mini-Cog scores ( P <0.0001) and high ACCI scores ( P =0.003) as independent risk factors for severe hemorrhagic events. The inclusion of GA scores with age enhanced predictive performance, achieving an area under the curve (AUC) of up to 0.96. Optimal thresholds for high-risk identification were age ≥80 years, Mini-Cog score ≤4, G8 score ≤14, and ACCI score ≥5.

GA scores are significantly associated with the risk of severe hemorrhagic complications after glaucoma surgery. Integrating GA-based risk stratification with traditional background factors enhances the prediction of high-risk cases, facilitating more individualized and safer surgical planning for elderly patients with glaucoma.