To evaluate whether pseudoexfoliation glaucoma (PXG) is associated with an increased hazard of developing central serous chorioretinopathy (CSCR) compared with primary open-angle glaucoma (POAG).

Retrospective cohort study using a multicenter, real-world electronic health record database.

Adults aged ≥ 18 years diagnosed with PXG (study group) or POAG (control group).

We obtained deidentified patient data from the TriNetX U.S. Collaborative Network. Patients with a history of age-related macular degeneration (AMD) or prior anti-vascular endothelial growth factor (anti-VEGF) therapy were excluded. We performed multivariable Cox proportional hazards models to estimate adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs), adjusting for baseline demographics; ocular and systemic comorbidities; psychiatric conditions; medication exposures (including corticosteroids); and prior ocular surgeries.

The primary outcome was the development of CSCR within 1- and 5-year follow-up periods following the glaucoma diagnoses.

A total of 10,347 patients with PXG and 205,065 with POAG were included. In the Cox proportional hazards model, PXG was significantly associated with a higher hazard of developing CSCR compared with POAG. The aHR for CSCR was 1.807 (95% CI, 1.041-3.136; P = .036) at the 1-year follow-up and 1.631 (95% CI, 1.014-2.622; P = .044) at 5 years.

PXG is associated with an increased hazard of developing CSCR compared with POAG. These findings suggest that PXG may be associated with an increased susceptibility to posterior segment vascular pathology. Prospective studies incorporating longitudinal imaging are warranted to further elucidate shared choroidal mechanisms underlying this association.