Risk of recurrent corneal erosion in patients with diabetes mellitus in Taiwan: a population-based cohort study

Abstract

ObjectiveTo investigate the risk of recurrent corneal erosion (RCE) in patients with diabetes mellitus (DM).Design, setting and participantsThis retrospective, nationwide, matched cohort study included 239 854 patients with DM recruited between 2003 and 2005 from the Longitudinal Cohort of Diabetes Patients database. The control group included the same number of age-matched and sex-matched patients without DM selected from the Taiwan Longitudinal Health Insurance Database, 2000. Data for each patient were collected from the index date until December 2013.Main outcomes and measuresThe incidence and risk of RCE were compared between the two groups. Cox proportional hazards regression was used to calculate the HR for RCE after adjustment for potential confounders. The cumulative RCE incidence rate was calculated using Kaplan–Meier analysis.ResultsIn total, 1236 patients with DM and 884 controls developed RCE during the follow-up period, resulting in an incidence rate of RCE in patients with DM (5.87/10 000 person-years (PY)) higher than that in the controls (4.23/10 000 PY). After adjustment for potential confounders, including hypertension, hyperlipidaemia, chronic renal disease and keratoconjunctivitis sicca, patients with DM were 1.35 times (95% CI, 1.24 to 1.48) more likely to develop RCE than the total sample cohort.ConclusionsDM increases the risk of RCE, which is an interdisciplinary issue. Therefore, close collaboration between endocrinologists and ophthalmologists is important in managing RCE following DM.

Association Between Atopic Keratoconjunctivitis and the Risk of Recurrent Corneal Erosion

“…In this cohort study, we evaluated these comorbidities in AKC patients and discovered that AKC patients with diabetes mellitus had a significantly higher IRR for RCE than the controls ( Table 2 ), and diabetes mellitus was a significant risk factor for the development of RCE in the whole cohort ( Table 3 ). This finding is consistent with several previous studies ( 6 , 7 , 31 ). Nanba et al ( 7 ) conducted a retrospective study including 21 eyes of 21 patients with RCE and found that diabetes mellitus is an important risk factor for RCE.…”

“…Further, we found that keratoconjunctivitis sicca is an independent risk factor for the development of RCE in the total cohort ( Table 3 ), although keratoconjunctivitis sicca did not lead to a significantly higher RCE incidence in the AKC patients and controls ( Table 2 ). The association between keratoconjunctivitis sicca and RCE has been reported in several papers ( 31 , 32 ). Our previous study showed the relationship between keratoconjunctivitis sicca and RCE in the total cohort of 239,854 patients with diabetes mellitus and 239,854 matched control ( 31 ).…”

“…The association between keratoconjunctivitis sicca and RCE has been reported in several papers (31,32). Our previous study showed the relationship between keratoconjunctivitis sicca and RCE in the total cohort of 239,854 patients with diabetes mellitus and 239,854 matched control (31). Keratoconjunctivitis sicca, characterised by inflammation and a loss of homeostasis of the tear film, is a complex ocular surface disorder and a multifactorial condition accompanied by many ocular symptoms, including discomfort, visual disturbance, and foreign body sensation (35).…”

“…Several studies have shown that comorbidities, such as diabetes mellitus ( 7 , 31 ), keratoconjunctivitis sicca ( 6 , 31 , 32 ), corneal transplantation ( 9 , 33 ), ocular blunt trauma ( 9 , 33 ), corneal dystrophy, and band keratopathy are associated with RCE. In this cohort study, we evaluated these comorbidities in AKC patients and discovered that AKC patients with diabetes mellitus had a significantly higher IRR for RCE than the controls ( Table 2 ), and diabetes mellitus was a significant risk factor for the development of RCE in the whole cohort ( Table 3 ).…”

“…Nanba et al ( 7 ) conducted a retrospective study including 21 eyes of 21 patients with RCE and found that diabetes mellitus is an important risk factor for RCE. Our previous retrospective, nationwide, matched cohort study that included 239,854 patients with diabetes mellitus showed that patients with diabetes mellitus were 1.35 times (95% CI, 1.24–1.48) more likely to develop RCE than the total sample cohort ( 31 ). The association between diabetes mellitus and RCE may be explained by the influence of hyperglycaemia in patients with diabetes mellitus on corneal morphology, and physiology including delayed epithelial wound healing, reduced basal epithelial cell density, and decreased sub-basal nerve density in the cornea of patients with diabetes mellitus ( 34 ).…”