Risk of Glaucoma in Patients With Idiopathic Noninfectious Uveitis: A Multi-Institutional Real-World Retrospective Cohort Study.

OBJECTIVE

To determine the risk of developing glaucoma following a diagnosis of idiopathic noninfectious uveitis and to stratify this risk by uveitis subtype, patient demographics, and corticosteroid use.

DESIGN

Retrospective cohort study using data from January 1, 2006, to December 31, 2024.

PARTICIPANTS

Adult patients with noninfectious uveitis were identified within a multi-institutional US collaborative federated research network. Patients with systemic autoimmune diseases were excluded to isolate ocular inflammation risk. After 1:1 propensity score matching for age, sex, race, comorbidities, and medication use, two balanced cohorts of 16,910 patients each were established.

METHOD: The exposure was a diagnosis of noninfectious uveitis. Patients were followed for the development of new glaucoma diagnoses, identified using ICD-10-CM codes. A sensitivity analysis using an ophthalmology encounters control group was performed to address potential surveillance bias.

MAIN OUTCOME MEASURES: The primary outcome was the incidence of a new glaucoma diagnosis after the index date, identified by ICD-10-CM codes.

RESULTS

Patients with noninfectious uveitis had a nearly 10-fold increased risk of developing glaucoma compared to controls (hazard ratio [HR], 9.63; 95% CI, 7.75-11.95). This risk remained robust in the sensitivity analysis (HR, 7.11; 95% CI, 6.21-8.15). The risk was highest during the first follow-up year (HR, 33.78; 95% CI, 19.02-59.90), and was significant across most subtypes, including primary open-angle glaucoma (HR, 4.47; 95% CI, 3.50-5.69), primary angle-closure glaucoma (HR, 11.55; 95% CI, 5.60-23.82), and drug-induced glaucoma (HR, 51.29; 95% CI, 16.35-160.00). Among uveitis subtypes, panuveitis was associated with the greatest risk (HR, 50.49; 95% CI, 22.36-113.00). Stratified analyses showed a markedly elevated uveitis risk for glaucoma in the youngest age group (18-49 years: HR, 36.65; 95% CI, 18.14-74.00). Both systemic (HR, 10.19; 95% CI, 6.34-16.37) and ophthalmic (HR, 5.67; 95% CI, 3.88-8.30) corticosteroid use were associated with increased uveitis risk for glaucoma.

CONCLUSIONS

Noninfectious uveitis is a significant risk factor for glaucoma, with the highest risk observed in younger adults, panuveitis patients, and during the first year after diagnosis. These findings underscore the need for a risk-stratified glaucoma surveillance to prevent irreversible vision loss.