Artificial intelligence for surgical outcome prediction in glaucoma: a systematic review.

Introduction: Glaucoma is a leading cause of irreversible blindness, and its rising global prevalence has led to a significant increase in glaucoma surgeries. However, predicting postoperative outcomes remains challenging due to the complex interplay of patient factors, surgical techniques, and postoperative care. Artificial intelligence (AI) has emerged as a promising tool for enhancing predictive accuracy in clinical decision-making. Methods: This systematic review was conducted to evaluate the current evidence on the use of AI to predict surgical outcomes in glaucoma patients. A comprehensive search of Medline, Embase, Web of Science, and Scopus was performed. Studies were included if they applied AI models to glaucoma surgery outcome prediction. Results: Six studies met inclusion criteria, collectively analyzing 4,630 surgeries. A variety of algorithms were applied, including random forests, support vector machines, and neural networks. Overall, AI models consistently outperformed traditional statistical approaches, with the best-performing model achieving an accuracy of 87.5%. Key predictors of outcomes included demographic factors (e.g., age), systemic health indicators (e.g., smoking status and body mass index), and ophthalmic parameters (e.g., baseline intraocular pressure, central corneal thickness, mitomycin C use). Discussion: While AI models demonstrated superior performance to traditional statistical approaches, the lack of external validation and standardized surgical success definitions limit their clinical applicability. This review highlights both the promise and the current limitations of artificial intelligence in glaucoma surgery outcome prediction, emphasizing the need for prospective, multicenter studies, publicly available datasets, and standardized evaluation metrics to enhance the generalizability and clinical utility of future models. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD42024621758, identifier: CRD42024621758.