Association between Metabolic Dysfunction-Associated Steatotic Liver Disease and Intraocular pressure-related outcomes: A systematic review

Introduction: Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) is increasingly recognized as a systemic metabolic disorder with potential ocular manifestations. Emerging evidence suggests a relationship between MASLD and glaucoma; however, findings remain inconsistent. We conducted a systematic review to evaluate the association between MASLD and intraocular pressure (IOP) related outcomes. Methods: We retrieved relevant articles from four databases (PubMed, Embase, Scopus, and Cochrane) and adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The primary outcomes were the proportion with glaucoma and the mean IOP among individuals with MASLD compared with those without fatty liver disease. A meta-analysis was performed to estimate the pooled mean difference (MD) with 95% confidence interval (CI) in IOP between the fatty liver and non-fatty liver groups, using a random-effects model. Results: Five observational studies involving more than 370,000 participants were included, with four retrospective and one prospective cohort. Across studies, individuals with fatty liver consistently demonstrated higher IOP and a greater risk of glaucoma-related outcomes compared with those without fatty liver disease. Increasing severity of fatty liver was associated with higher IOP in three studies. A meta-analysis comprising 23,625 participants (7,409 with fatty liver and 16,216 healthy) demonstrated a significantly higher mean IOP in patients with fatty liver (MD: 0.81 mmHg; 95% CI: 0.51-1.10; p=0.007). Conclusions: Current evidence suggests that patients with MASLD have higher intraocular pressure. Individuals with MASLD may represent a high-risk population warranting ophthalmic screening and closer metabolic risk assessment.