Shifting Paradigms in Glaucoma Management: A Retrospective Analysis from 2013 to 2023

PURPOSE: This study analyzes trends in glaucoma surgical management at the Eye & ENT Hospital of Fudan University over a 10-year period (2013-2023), focusing on the evolution of surgical practices and the adoption of new techniques. METHODS: A retrospective observational study was conducted using medical records of patients diagnosed with glaucoma who underwent surgery between January 1, 2013, and December 31, 2023. Data were analyzed using the Cochrane-Armitage trend test. RESULTS: A total of 13,092 glaucoma surgeries were performed, increasing from 736 in 2013 to 2,451 in 2023. Primary angle-closure glaucoma (PACG) accounted for 71.00% (9247/13092) of cases. Patients were predominantly aged 40-64 (43.56%) and 65+ (41.12%), with 56.60% female and 43.40% male. Internal filtration surgeries dropped between 2013-2015 but rose from 2.95% (26/880) in 2015 to 7.87% (193/2451) in 2023. External filtration surgeries declined from 82.47% (607/736) to 26.56% (651/2451). Phacoemulsification combined with goniosynechialysis (Phaco+GSL) increased from 7.61% (56/736) to 65.36% (1602/2451), while cyclodestruction procedures remained stable (0.54% to 0.20%). In congenital glaucoma (CG), ab interno trabeculotomy rose to 52.74% (77/146) by 2023. External filtration for primary open-angle glaucoma (POAG) decreased from 98.54% (135/137) to 74.82% (312/417), while Phaco+GSL for PACG increased from 11.43% (56/490) to 84.36% (1591/1886). Among glaucoma drainage devices (GDDs), Ahmed Glaucoma Valve usage declined from 94.25% (246/261) to 61.66% (193/313), while the Ex-Press device was phased out, and XEN Gel Stent (MIGS) usage rose to 38.34% (120/313). CONCLUSION: Glaucoma surgical management at the Eye & ENT Hospital of Fudan University has evolved significantly over the past decade, with a notable shift towards minimally invasive procedures and personalized treatment strategies.