Increasing Incidence of Conjunctival Lesion Excisions After Popularization of Prostaglandin Analogs

Choi, Daniel

Increasing Incidence of Conjunctival Lesion Excisions After Popularization of Prostaglandin Analogs

Monday, April 28, 2014: 2:11 PM

Room 155 (Boston Convention and Exhibition Center)

Daniel Youngjun Choi, MD, Byers Eye Institute at Stanford, Palo Alto, CA, USA

Robert Chang, MD Palo Alto, CA, USA

Kamyar Vaziri, MD Palm beach gardens, FL, USA

Darius M. Moshfeghi, MD, BYERS EYE INSTITUTE AT STANFORD, PALO ALSO, CA, USA

Andrew A. Moshfeghi, MD, MBA, Retina Associates of Kentucky, LEXINGTON, KY, USA

Suzann Pershing, MD, MS, Stanford University School of Medicine, VA Palo Alto Health Care System, Stanford, CA, USA

Narrative Responses:

Purpose
Recent literature suggests that prostaglandin analogs may be associated with acquired conjunctival pigmentation, which may mimic ocular surface malignancy or premaligancy. This study is to investigate the incidence of conjunctival lesion excisions conducted several years after the popularization of prostaglandin analogs for the treatment of glaucoma and ocular hypertension.

Methods
A representative nationwide outpatient claims database (Marketscan; Truven Health Analytics) was queried to identify the number of patients undergoing excision of conjunctival lesions on an annual basis from 2007 to 2011. Incidence was calculated based on the total number of patients sampled each year. Procedures were identified by CPT code: 68100 (biopsy of conjunctiva), 68110 (excision of lesion conjunctiva; up to 1 cm), or 68115 (excision of lesion conjunctiva; over 1 cm).

Results
A rising trend in the incidence of conjunctival lesion excisions was identified (paralleling previously-reported increase in usage of prostaglandin analogs). In 2007, the total number of conjunctival lesion excisions was 2,024 patients out of 28,423,580 patients overall (0.007%); in 2008, 3,105 patients out of 19,389,609 patients (0.016%); in 2009, 3416 patients out of 14,748,257 patients (0.023%); in 2010, 3,282 patients out of 12,541,444 patients (0.026%), and in 2011, 3,044 patients out of 11,941,894 patients (0.025%) underwent conjunctival excisions.

Conclusion
Concurrent with increasing use of prostaglandin analogs, there has been a trend towards an increased number of conjunctival lesion excisions. Although an association cannot be proven, this trend does highlight the importance of future studies to investigate if patients are undergoing unnecessary surgical excision of benign lesions.