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Long-Term Risk of Mortality and Systemic Morbidity in Neovascular Glaucoma: A Multicenter Retrospective Cohort Study
Ryan Margolis1, Pranav Vasu2, Syril K Dorairaj3
1Department of Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, New York.
Purpose:
To evaluate long-term systemic risks associated with neovascular glaucoma (NVG) using a large observational data set from the TriNetX Research Network.
Design:
Retrospective cohort study.
Subjects:
Adults >40 years old with central retinal vein occlusion (CRVO) or proliferative diabetic retinopathy (PDR) were compared based on whether they did or did not subsequently develop NVG.
Methods:
Patients were propensity score matched 1:1 based on demographics and comorbidities. Outcomes were assessed at 1, 5, and 10 years using hazard ratios (HRs) with 95% confidence intervals (CIs). Subgroup analysis compared outcomes in PDR + NVG versus CRVO + NVG. Neovascular glaucoma patients were also compared with a cataract control cohort.
Main Outcome Measures:
Risk of all-cause mortality, stroke, myocardial infarction (MI), end-stage renal disease (ESRD), and deep vein thrombosis (DVT).
Results:
Patients with PDR who developed NVG had a higher long-term risk than PDR alone, including elevated 10-year mortality (HR, 1.34; 95% CI, 1.14-1.57) and ESRD (HR, 1.43; 95% CI, 1.23-1.67). Among patients with CRVO, the development of NVG increased 10-year mortality (HR, 1.61; 95% CI, 1.17-2.20) and stroke (HR, 1.86; 95% CI, 1.19-2.90), whereas MI and ESRD were not significantly different. DVT risk was not significantly different. Subgroup comparison showed that PDR + NVG had a higher 10-year risk of mortality (HR, 1.56; 95% CI, 1.17-2.07), MI (HR, 1.94; 95% CI, 1.13-3.32), and ESRD (HR, 4.04; 95% CI, 2.43-6.73) compared with CRVO + NVG. Compared with cataract control at 10 years, NVG was associated with higher risks of mortality (HR, 2.66; 95% CI, 2.40-2.94), stroke (HR, 2.17; 95% CI, 1.85-2.54), MI (HR, 1.89; 95% CI, 1.60-2.23), and ESRD (HR, 3.34; 95% CI, 2.89-3.88).
Conclusions:
Neovascular glaucoma itself appears to add systemic risk beyond underlying PDR or CRVO, suggesting that the onset of NVG may represent a critical breakpoint in the spectrum of systemic vascular disease. Our results highlight the importance of coordinated ophthalmic and multispecialty care at the time of diagnosis.
Financial Disclosure(S):
The authors have no proprietary or commercial interest in any materials discussed in this article.
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