Assessing Prostaglandin-Analog-Associated Uveitis in Childhood Glaucoma

To evaluate the association between prostaglandin analogue (PGA) use and the development of uveitis in children and young adults with glaucoma.

We conducted a retrospective cohort study of patients ≤ 20 years of age with glaucoma, using the TriNetX United States Collaborative Network, a federated electronic health record database that aggregates de-identified clinical data, including diagnoses, procedures, medications, and demographics, from 67 healthcare organizations. Patients ≤ 20 years with glaucoma were identified using International Classification of Diseases, Tenth Revision (ICD-10) codes. Patients with a prior diagnosis of uveitis were excluded. We defined exposure as the new initiation of a PGA after a glaucoma diagnosis. We defined comparator groups as those who received topical β-blockers or carbonic anhydrase inhibitors (CAIs), excluding patients who used other glaucoma medications within the prior 3 months or had a history of uveitis. A minimum of 180 days of follow-up was necessary for inclusion to identify incident uveitis using International Classification of Diseases, Tenth Revision codes for anterior, posterior, or panuveitis. We used Cox proportional hazards models, adjusted for demographics, type 1 diabetes, aphakia, and ocular surgeries, to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs).

We identified 980 PGA initiators, 996 β-blocker initiators, and 477 CAI initiators. Uveitis occurred rarely within 180 days across all treatment groups, with 11 uveitis events observed among the β-blocker cohort, and fewer than 10 uveitis events observed among each of the PGA and CAI cohorts. Using β-blockers as the reference group, PGA initiation was associated with a significantly lower hazard of uveitis (aHR 0.20; 95% CI, 0.14-0.29; p < 0.01). In contrast, CAI initiation was not significantly different from β-blocker initiation (aHR 0.69; 95% CI, 0.46-1.04; p = 0.17). Increasing age increased the hazard of uveitis, whereas male sex and aphakia decreased the hazard.

Among children and young adults with glaucoma, PGAs did not increase the hazard of uveitis during 180 days of follow-up and showed a lower hazard than β-blockers or CAIs.