Association Between Atopic Keratoconjunctivitis and the Risk of Recurrent Corneal Erosion.

Ren-Long Jan,Jhi-Joung Wang,Sung-Huei Tseng,Yuh-Shin Chang,Shih-Feng Weng

doi:10.3389/fmed.2021.688355

Abstract

Purpose: To investigate the risk of recurrent corneal erosion (RCE) in patients with atopic keratoconjunctivitis (AKC).Methods: This national, retrospective, matched cohort study enrolled 184,166 newly-diagnosed AKC patients, selected from the Taiwan National Health Insurance Research Database and identified by the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code 372.05. The control group comprised 184,166 non-AKC patients matched by age, sex, and potential comorbidities and they were selected from the Taiwan Longitudinal Health Insurance Database, 2000. Information from patients was gathered from 1 January 2004 to 31 December 2011, and both groups were traced from the index date until December 2013. The incidence and risk of RCE (ICD-9-CM code 361.42) was compared between the groups. The adjusted hazard ratio (HR) for RCE was obtained by a Cox proportional hazard regression analysis. The Kaplan–Meier analysis was performed to calculate the cumulative incidence of RCE.Results: In total, 564 AKC patients and 406 non-AKC controls developed RCE during the follow-up span. The incidence of RCE was 1.45 times higher in AKC patients than in controls (95% confidence interval [CI] = 1.27–1.64; P < 0.0001). After adjusting for potential confounders, including diabetes mellitus, keratoconjunctivitis sicca, corneal transplantation, ocular blunt trauma, corneal dystrophy, and band keratopathy, AKC patients were 1.36 times more likely to develop RCE than controls (adjusted HR, 1.36; 95% CI = 1.19–1.54; p < 0.05).Conclusions: AKC Patients had an increased risk of developing RCE and should be informed of this risk.

Highlights

Atopic keratoconjunctivitis (AKC), a chronic, non-infectious inflammatory ocular surface situation, is the most severe condition of allergic conjunctival disease
The incidence of Recurrent corneal erosion (RCE) was 1.45 times higher in AKC patients than in controls (95% confidence interval [CI] = 1.27–1.64; P < 0.0001)
After adjusting for potential confounders, including diabetes mellitus, keratoconjunctivitis sicca, corneal transplantation, ocular blunt trauma, corneal dystrophy, and band keratopathy, AKC patients were 1.36 times more likely to develop RCE than controls

Summary

Introduction

Atopic keratoconjunctivitis (AKC), a chronic, non-infectious inflammatory ocular surface situation, is the most severe condition of allergic conjunctival disease. The symptoms of patients with AKC include itching, redness, tearing, pain in the eyes, and blurred vision [1, 2]. Patients with AKC often present characteristics such as eyelid thickening and oedema, conjunctival congestion and thickening, tear film instability and dysfunction, and corneal scarring and neovascularization [2, 3]. Recurrent corneal erosion (RCE), a relative common disorder worldwide, is characterized by recurrent detachment of the corneal epithelium from the basement membrane. The most frequent clinical presentation of RCE is sudden onset of eye pain accompanied by associated symptoms including photophobia, redness and tearing [5, 6]. Corneal epithelial basement membrane dystrophies and mechanical or surgical trauma to the corneal epithelium are important risk factors for RCE [5, 7]. Inflammation related to corneal surface injury results in weakening of the extra-cellular adhesion network and disruption of the basement membrane [8, 9]

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Results

Conclusion