Long-Term Survival After Glaucoma Surgery: A Real-World Retrospective Analysis​

Purpose To evaluate postoperative survival after glaucoma surgery in older adults and to identify age- and comorbidity-related predictors of mortality, in order to assess whether patients live long enough to potentially benefit from surgery. Methods We conducted a retrospective observational cohort study including patients aged ≥ 65 years who underwent glaucoma surgery at a tertiary referral hospital between 2015 and 2020. Patients were followed until death or administrative censoring in 2025. Overall survival was estimated using Kaplan–Meier methods and compared across predefined age groups. Cox proportional hazards regression was used to identify predictors of mortality. Results Of 639 patients undergoing glaucoma surgery, 390 met inclusion criteria. The mean age at surgery was 75.7 ± 6.5 years, and the median postoperative follow-up was 4.8 years. During follow-up, 45 patients (11.5%) died, with a median time from surgery to death of 3.1 years (IQR 1.4–4.5). The estimated overall survival probability was 95.7% at two years and 88.0% at five years. Survival differed significantly across age groups (log-rank p = 0.0097), with the highest mortality observed in patients aged ≥ 85 years. In multivariable Cox regression analysis adjusting for ASA classification, age ≥ 85 years (HR 2.42, 95% CI 1.04–5.67) and higher perioperative risk (ASA III–IV; HR 2.99, 95% CI 1.64–5.47) were independently associated with increased mortality. Postoperative healthcare utilization within six months did not differ across age groups. Conclusions Older patients—including those with advanced age and higher perioperative risk—survived long enough to potentially benefit from glaucoma surgery. While age ≥ 85 years and elevated ASA classification were associated with increased mortality, these factors alone should not preclude surgical intervention.