血管新生緑内障における死亡率および全身性罹患率の長期リスク：多施設共同後ろ向きコホート研究

To evaluate long-term systemic risks associated with neovascular glaucoma (NVG) using a large, real-world dataset from the TriNetX Research Network.

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.

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 NVG+PDR versus CRVO+NVG. NVG patients were also compared to a cataract control cohort.

Risk of all-cause mortality, stroke, myocardial infarction (MI), end-stage renal disease (ESRD), and deep-vein thrombosis (DVT).

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, 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), while MI and ESRD were not significantly different. DVT risk was not significantly different. Subgroup comparison showed that PDR-NVG had 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).

NVG 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.