Ambient Particulate Matter Exposure Increases the Risk of Suboptimal Outcomes of Glaucoma Surgery

Purpose: Postoperative suboptimal outcome is a big challenge for patients undergoing conjunctival incision glaucoma surgery. This study aimed to investigate the association between particulate matter exposure and postoperative outcomes within different periods. Design: A retrospective, population-based cohort study. Participants: A total of 6,141 patients who underwent conjunctiva incision glaucoma surgeries from January 2015 to December 2023. Methods: Patient data, including outcomes, demographics, medical and surgical history were collected from the Eye and Ear, Nose, Throat Hospital, Fudan University. Air pollution data were obtained using bilinear interpolation. The relationship between particulate matter (PM) exposure and suboptimal surgical outcomes was analyzed using survival analysis, Cox proportional hazards regression and restricted cubic splines. The combined effect of exposure level and windows was calculated during 20 to 100 days after surgery. Subgroup analyses assessed interaction effects. Main Outcome Measures: Hazard ratios (HRs) and 95% confidence intervals (CIs) for suboptimal surgical outcomes in relation to an interquartile range (IQR) increase of PM exposure levels. Results: Individuals exposed to higher levels of PM showed suboptimal surgical outcomes more rapidly. Higher exposure to PMs was significantly associated with increased cumulative hazards of suboptimal surgical outcomes, within the first 90 days after glaucoma surgery particularly, with hazard ratios of 1.0731 (95%CI: 1.0334-1.1144) and 1.0412 (95%CI: 1.0160-1.0671) for each 10 µg/m ³ increase in PM _2.5 and PM ₁₀ , respectively. The cumulative effects of PMs beyond the threshold exposure level (60 µg/m ³ for PM _2.5 , and 80 µg/m ³ for PM ₁₀ ) became more significant over time. Male patients and those aged < 60 years exhibited significantly elevated risks of adverse surgical outcomes specifically during the 60- and 90-day postoperative PM exposure windows. The robustness of the conclusion was confirmed by sensitivity analyses. Conclusions: Ambient PM exposure significantly increases the risk of suboptimal outcomes of conjunctival incision glaucoma surgery, especially within 90 days after surgery. Given the ubiquity of ambient air pollution, proactive integration of PM exposure evaluation into surgical planning and postoperative care protocols may warrant consideration in ophthalmic practice.