Neutrophil-to-Lymphocyte Ratio as a Potential Biomarker for Neovascular Glaucoma in Proliferative Diabetic Retinopathy: A Pilot Case-Control Study

Aim: To compare haematological indices among controls and proliferative diabetic retinopathy (PDR) patients, with and without neovascular glaucoma (NVG), and evaluate their association as potential biomarkers. Materials and Methods: Hospital-based case-control pilot study ( n = 90) compared neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio and lymphocyte-monocyte ratio from routine complete blood counts in age-/sex-matched groups: 30 normal controls, 30 PDR without NVG, 30 PDR with NVG. The sample size provided 80% power to detect moderate NLR differences ( d = 0.8, α = 0.05). One-way analysis of variance, post-hoc t-tests and multivariate logistic regression were performed. Results: NLR increased progressively: 1.40 ± 0.39 (controls), 2.06 ± 0.72 (PDR without NVG), 2.69 ± 0.86 (PDR with NVG); all pairwise p < 0.01. Multivariate analysis identified NLR as independently associated with NVG (OR 4.12, 95% confidence interval [CI] 2.34–7.25, p < 0.001) within the PDR cohort. Conclusion: Elevated NLR was significantly associated with the presence of NVG among patients with PDR. As an inexpensive and readily available inflammatory marker, NLR may have potential utility as an adjunctive biomarker; however, larger prospective studies are required before its role in risk stratification or clinical decision-making can be established.