Publication date: Jul 12, 2025

An underlying association between primary open-angle glaucoma (POAG) and COVID-19 has been hypothesized, but the causal link and shared mechanisms remain unclear. This study integrates epidemiological and bioinformatics approaches to investigate their relationship, aiming to identify common molecular pathways and validate clinical correlations. Epidemiological data from 3,015 participants in the CHARLS database were analyzed using multivariate logistic regression and Cox proportional hazards models to assess the association between COVID-19 and POAG, with stratification by gender, smoking status, and alcohol consumption. Concurrently, gene expression datasets from GEO (POAG: GSE27276; COVID-19: GSE171110, GSE152418) were used to identify 57 crosstalk genes (CGs) via differential expression analysis. Machine learning algorithms (LASSO, SVM-RFE, Random Forest) were applied to screen POAG diagnostic biomarkers from CGs, followed by construction of transcription factor (TF)-microRNA (miRNA)-protein-compound regulatory networks and consensus clustering to characterize COVID-19 immune microenvironment subtypes. Epidemiological analyses revealed that COVID-19 was an independent risk factor for POAG, with adjusted odds ratios (ORs) of 12. 775-15. 688 and hazard ratios (HRs) of 4. 893-5. 060 (all P 

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