Further research is needed to assess risk factors for pterygium recurrence
A new analysis from the Intelligent Research in Sight Registry (IRIS) has suggested that of more than 80,000 pterygium excisions, those at high risk of reoperation within 5 years were young, male and publicly insured.
Led by Isdin Oke, MD, Department of Ophthalmology, Boston Children’s Hospital, study investigators reported that while the association of pterygium recurrence by age and gender had previously been reported, the association with the type of insurance is new.
Oke noted that this “may suggest that differences associated with socioeconomic status, such as occupational or environmental exposures, may increase the risk of recurrence, although unmeasured confounding factors may also influence decisions to undergo further relapse.” operation”.
Practice models can be better informed if clinicians understand the factors associated with pterygium reoperation. Data from the IRIS registry was analyzed to assess the risk factors involved, with investigators including patients who underwent the procedure between January 2013 and December 2020.
They defined initial surgery as the first pterygium excision performed for each patient in each eye and then defined reoperation as any pterygium excision performed in the same eye within the study interval at least 1 month after the initial surgery. . Only one eye was randomly selected for patients who underwent bilateral pterygium excision.
Oke and colleagues calculated the cumulative probability of reoperation within 5 years of first pterygium excision using a Kaplan-Meier estimator. They quantified the association between reoperation and risk factors, including age at surgery, gender, race and ethnicity, smoking status, geographic location, subspecialty surgeon and volume using multivariate Cox proportional hazards regression models.
The study included 87,042 patients undergoing pterygium excision. The cohort was composed of 57% (n = 49,329) men and 30% (n = 21,037) publicly insured, with an average age of 58 years. The data show that the cumulative probability of pterygium reoperation was 5.7% (95% CI, 5.4% – 6.0%) within 5 years of the initial surgery and decreased with age.
A higher risk of reoperation was associated with younger age (relative risk [HR]1.36 per decade [95% confidence interval [CI]1.31 – 1.41; P P = 0.002), public insurance (HR, 1.37; 95% CI, 1.22, 1.53; P P = 0.008).
In contrast, a lower risk was associated with surgery performed by a corneal specialist (HR, 0.63; 95% CI, 0.55, 0.72; P <.001 and surgeries performed by high-volume surgeons.>
This may suggest a potential benefit to studying the adjuvant techniques and therapies used by these surgeons, according to the study researchers. They added that reoperations may have been underestimated if aftercare for patients was not received at practices participating in the IRIS registry.
“Further research is needed to understand the factors associated with pterygium recurrence and to extrapolate these findings to guide practice models,” Oke concluded.
The study, “Risk factors associated with pterygium reoperation in the IRIS registrywas published in JAMA Ophthalmology.