Metabolomic Analysis of Aqueous Humor to Predict Glaucoma Progression and Overall Survival After Glaucoma Surgery—The MISO II Study

BACKGROUND/OBJECTIVES: Although advances in understanding glaucoma have been made, early detection remains challenging due to the asymptomatic nature of the disease. The Metabolomics In Surgical Ophthalmological Patients (MISO) study previously demonstrated that aqueous humor (AH) metabolomics can distinguish glaucoma patients from controls. We aimed to determine if the metabolic profile of AH has predictive power for overall survival and glaucoma progression after surgery. METHODS: = 34) were retrospectively analyzed and classified into progression categories based on surgical and medical interventions and assessed for survival. RESULTS: Glutamine and α-ketoglutarate were significantly associated with glaucoma progression, while N-acetylglutamate, lysine, and creatine correlated with mortality. These metabolites are linked to excitotoxicity, mitochondrial dysfunction, and oxidative stress, highlighting their potential role in glaucoma pathophysiology. CONCLUSIONS: These results suggest that metabolomic profiling of AH could provide valuable biomarkers for predicting surgical outcomes and overall survival, paving the way for individualized therapeutic approaches. Further studies are required to confirm these findings before they can be integrated into clinical practice.