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

Patients with neovascular glaucoma had significantly higher SHR values than those without NVG.

• Median SHR was 0.96 in NVG patients versus 0.82 in non-NVG patients.
• The difference was statistically significant (p < 0.001).
• The study included 49 patients with NVG and 215 without NVG.
• SHR was calculated as admission blood glucose (mmol/L) divided by (1.59 × HbA1c − 2.59).

The SHR was independently associated with prevalent neovascular glaucoma after multivariable adjustment.

• Adjusted odds ratio per 0.1-unit SHR increment was 1.31 (95% CI 1.12–1.53; p < 0.001).
• Firth penalized regression produced a nearly identical estimate (aOR 1.29, 95% CI 1.11–1.50).
• A sensitivity model excluding HbA1c was also fitted.
• The events-per-variable ratio was 6.1, indicating limited model capacity.

Patients with neovascular glaucoma were significantly younger than those without NVG.

• Median age was 57.0 years in the NVG group versus 62.0 years in the non-NVG group.
• The difference was statistically significant (p < 0.001).
• Non-normally distributed variables were compared using the Mann-Whitney U test.
• A Bonferroni-adjusted significance threshold of 0.0063 was applied for eight baseline comparisons.

The discrimination ability of the model was modest after internal validation.

• The optimism-corrected C-statistic was 0.724.
• Internal validation was performed by bootstrap resampling.
• Subgroup estimates were described as 'statistically unstable' and reported as exploratory only.

Reverse causation is a key limitation because established NVG may itself elevate admission glucose through acute stress.

• The study design was retrospective and cross-sectional, precluding causal inference.
• The authors explicitly state that 'because established NVG may itself increase admission glucose through acute stress, reverse causation cannot be excluded.'
• The authors describe findings as 'hypothesis-generating' requiring confirmation in prospective, externally validated cohorts.
• No clinical application was recommended based on these findings alone.

The study was conducted at a single center (Shaoxing People's Hospital) between 2023 and 2025 using a retrospective cross-sectional design.

• Total sample size was 264 patients with proliferative diabetic retinopathy (49 NVG, 215 non-NVG).
• Patients were categorized according to NVG status at presentation.
• The primary effect measure was per-0.1-unit SHR increment.
• The study did not include external validation.