Recent Trends in Declining Laser Peripheral Iridotomy for Angle Closure with Rising Cataract Surgeries: A Nationwide Cohort Study

초록

Purpose : To analyze recent trends in cataract surgeries and laser peripheral iridotomy (LPI) in Korea over six years, including during the coronavirus disease 2019 pandemic, by examining their correlation, influencing factors, and outcomes. Methods : A nationwide, population-based cohort study. Data from the Korean National Health Insurance Service were analyzed for patients aged 65 years or older who underwent cataract surgery or LPI between 2016 and 2021. Primary outcomes included the annual number and rate of patients undergoing cataract surgery and LPI, the correlation between yearly trends in cataract surgery and LPI, patient demographics, the proportion of patients undergoing cataract surgery after LPI, and the time interval to cataract surgery. Results : Between 2016 and 2021, cataract surgeries increased annually until 2019, declined in 2020, and rose again in 2021 among individuals aged 65 or older, while LPI procedures steadily declined after 2017. A negative correlation was found between annual cataract surgeries and LPIs (r = -0.657, P = 0.156), which was statistically significant in those aged 65-74 (r = -0.943, P = 0.005) and stronger in females (r = -0.771, P = 0.072) compared to males (r = -0.543, P = 0.266). In the LPI group, 73.2% were female. Among LPI patients, 92.11% later underwent cataract surgery, with 50% receiving it within four months (median = 121 days). Conclusions : This study identified a correlation between the recent increase in cataract surgeries and the decrease in LPI procedures. It is the first epidemiological analysis showing that most individuals who undergo LPI also undergo cataract surgery shortly afterward. These findings suggest that cataract surgery may provide a more favorable long-term prognosis than LPI in patients with primary angle-closure disease, regardless of cataract severity.