The impact of growth hormone therapy on ocular structural parameters in idiopathic short stature: a systematic review and meta-analysis

Clinical Snapshot

Key Findings

• P Value: Significant only for refractive status outcome

• Effect Size: Refractive status: MD = 0.53 (95% CI: 0.20 to 0.86); Axial length: MD = 0.72 (95% CI: -0.36 to 1.81)

• Primary Outcome: No significant associations found for most ocular parameters

• Nnt Or Sensitivity: Clinical significance unclear due to high heterogeneity and small effect sizes

• Confidence Interval: Wide confidence intervals crossing null for most outcomes except refractive status

Clinical Application

Routine ophthalmological monitoring is feasible but evidence insufficient to mandate specific protocols GH therapy is PBS-subsidised for specific indications in Australia; TGA-approved preparations available; RACGP guidelines may need consideration of ophthalmological monitoring Children with idiopathic short stature receiving growth hormone therapy

Abstract

This study aimed to conduct a systematic review and meta-analysis of the effects of growth hormone (GH) therapy on ocular structures and biometric parameters in children with idiopathic short stature (ISS), synthesizing existing evidence for future research. We systematically searched PubMed, EMBASE, the Cochrane Library, CNKI, Wanfang, and VIP databases from inception to September 2025. Randomized controlled trials and observational studies comparing the effects of GH therapy versus control on ocular biometric and refractive outcomes in children with ISS were included. Study quality was assessed using the Cochrane Risk of Bias Tool (RoB 2) and the NOS. Meta-analysis was performed using R software version 4.3.2, with effect sizes expressed as MD or SMD and 95% CI. Nine studies were included (4 RCTs, 5 cohort studies). Meta-analysis showed no significant association of GH therapy with corneal curvature (SMD = 0.13, 95% CI: -0.34 to 0.61). For axial length, the random-effects model showed no significant difference (MD = 0.72, 95% CI: -0.36 to 1.81), with high heterogeneity (I2 = 91.7%). Similarly, no significant association was found for intraocular pressure (MD = 1.38, 95% CI: -0.66 to 3.43; I2 = 95.9%). However, a significant association was observed for refractive status (MD = 0.53, 95% CI: 0.20 to 0.86; I2 = 0.0%). Sensitivity analysis showed robust results for corneal curvature and refractive outcomes, while axial length and intraocular pressure results were influenced by individual studies. Funnel plots and Egger's test indicated no significant publication bias.Conclusion: The associations between GH therapy and ocular biometric parameters in children with ISS remain uncertain. Current evidence suggests a possible link with refractive changes but shows no significant associations with axial length or intraocular pressure when accounting for high heterogeneity. The findings are inconsistent and should be regarded as hypothesis-generating, insufficient to recommend changes in clinical monitoring practice. Future large-sample, long-term studies are required.

References

1. 1.Fu, Q., Jin, H., & Zhang, L. (2026). The impact of growth hormone therapy on ocular structural parameters in idiopathic short stature: a systematic review and meta-analysis. European Journal of Pediatrics. https://doi.org/10.1007/s00431-025-06661-0