Cancer Type-Specific Risks of Retinal Vascular Occlusion: A Nationwide Population-Based Study

To evaluate the incidence and risk of retinal artery occlusion (RAO) and retinal vein occlusion (RVO) in cancer survivors across anatomical cancer subgroups.

Retrospective, nationwide, population-based cohort study.

A total of 462,185 individuals newly diagnosed with cancer in South Korea between 2011 and 2022 were included in the main analysis.

Incident cancer cases were identified from the Korean National Health Insurance Sharing Service database. Malignancies were classified into 15 anatomical subgroups according to the International Classification of Diseases, Tenth Revision. Patients with multiple primary cancers or prior RAO or RVO were excluded. Risks of RAO and RVO were evaluated using age- and sex-adjusted standardized incidence ratios (SIRs) compared with the general population and multivariable Cox and Fine-Gray hazard models within the cancer cohort. Sensitivity analyses were performed.

Incident RAO and RVO after cancer diagnosis.

During a mean follow-up of 7.3 years, 873 RAO and 6,657 RVO cases were identified. The 5-year cumulative incidence was 0.13% (95% confidence interval [CI], 0.12-0.14) for RAO and 0.91% (95% CI, 0.88-0.94) for RVO. Compared with the general population, cancer survivors had increased risks of RAO (SIR, 1.27; 95% CI, 1.19-1.36; P < 0.001) and RVO (SIR, 1.15; 95% CI, 1.12-1.17; P < 0.001). Hematologic malignancies showed the highest risk for RAO (SIR, 2.50; 95% CI, 1.80-3.38; P < 0.001; hazard ratio [HR], 1.92; 95% CI, 1.41-2.62; P = 0.001) and an increased risk for RVO (SIR, 1.52; 95% CI, 1.33-1.73; P < 0.001; Cox HR, 1.33; 95% CI, 1.17-1.52; P < 0.001). Eye and adnexa cancers showed the highest risk for RVO (SIR, 3.03; 95% CI, 1.56-5.29; P = 0.002; Fine-Gray HR, 2.47; 95% CI, 1.41-4.34; P = 0.002). Findings were consistent in sensitivity analyses.

Cancer survivors have significantly increased risks of both RAO and RVO compared with the general population. Hematologic malignancies showed elevated risks for both outcomes, whereas eye and adnexa cancers were most strongly associated with RVO. RVO may be a relevant vascular complication warranting further study in cancer survivorship.