Association between the stress hyperglycemia ratio and neovascular glaucoma in patients with proliferative diabetic retinopathy.

BACKGROUND

Neovascular glaucoma (NVG) is a sight-threatening complication of proliferative diabetic retinopathy (PDR). The stress hyperglycemia ratio (SHR), which quantifies the discrepancy between acute admission glucose and chronic glycemic background, has been associated with adverse outcomes in diabetic populations, but its relationship with NVG remains unknown.

OBJECTIVE

To examine the association between the SHR and prevalent NVG among patients with PDR.

METHODS

In this retrospective cross-sectional study, patients with PDR presenting to Shaoxing People's Hospital between 2023 and 2025 were categorized according to NVG status (49 with NVG; 215 without). The SHR was calculated as admission blood glucose (mmol/L) ÷ (1.59 × HbA1c - 2.59). Multivariable logistic regression estimated adjusted odds ratios (aORs), with the per-0.1-unit SHR increment as the primary effect measure; Firth penalized regression and a model excluding HbA1c were fitted as sensitivity analyses. Non-normally distributed variables were compared using the Mann-Whitney U test, with a Bonferroni-adjusted threshold of 0.0063 for the eight baseline comparisons. Discrimination was internally validated by bootstrap resampling.

RESULTS

Patients with NVG were younger (median 57.0 vs. 62.0 years; p < 0.001) and had higher SHR values (median 0.96 vs. 0.82; p < 0.001). The SHR was independently associated with prevalent NVG (aOR per 0.1-unit increment 1.31, 95% CI 1.12-1.53; p < 0.001); the Firth-penalized estimate was nearly identical (aOR 1.29, 95% CI 1.11-1.50). The events-per-variable ratio was 6.1; subgroup estimates were statistically unstable and are reported as exploratory only. The optimism-corrected C-statistic was 0.724.

CONCLUSIONS

In this cross-sectional analysis, an elevated SHR was associated with a higher prevalence of NVG among patients with PDR. Because established NVG may itself increase admission glucose through acute stress, reverse causation cannot be excluded. These hypothesis-generating findings require confirmation in prospective, externally validated cohorts before any clinical application can be considered.