Association of neovascular glaucoma with increased mortality and cardiovascular risk: a multicenter propensity-matched study.

Neovascular glaucoma (NVG) is a severe, vision-threatening secondary glaucoma associated with ocular ischemia and systemic vascular disease. Whether NVG also serves as a marker of systemic vascular risk remains unclear. In this retrospective, multicenter cohort study, adults with NVG were identified from a global electronic health record network and 1:1 propensity score matched to controls, accounting for demographics, comorbidities, medications, and healthcare utilization. Follow-up was up to 10 years. Primary outcomes were all-cause mortality, myocardial infarction, stroke, cardiac arrest, and three-point major adverse cardiovascular events (3P-MACE). Sensitivity analyses compared NVG with primary open-angle glaucoma (POAG) and examined subgroups with proliferative diabetic retinopathy, retinal vein occlusion, or ocular ischemic syndrome. Among 17,020 matched pairs, NVG was associated with higher risks of all-cause mortality (HR 1.70, 95% CI 1.60-1.81), myocardial infarction (HR 1.53, 95% CI 1.40-1.67), cardiac arrest (HR 1.57, 95% CI 1.36-1.82), stroke (HR 1.62, 95% CI 1.48-1.79), and 3P-MACE (HR 1.59, 95% CI 1.51-1.68). Findings were consistent across sensitivity and ischemic retinal subgroups. NVG is associated with increased long-term mortality and cardiovascular events, suggesting that its occurrence may identify patients with higher systemic vascular risks and supporting the need for proactive cardiovascular assessment.