Long-Term Risk of Mortality and Systemic Morbidity in Neovascular Glaucoma: A Multicenter Retrospective Cohort Study.

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.