Abstract
This nationwide, retrospective, matched cohort study was designed to investigate the risk of corneal ulcer in patients with diabetes mellitus (DM). It included 238,701 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- and sex-matched non-DM patients selected from the Taiwan Longitudinal Health Insurance Database, 2000. The data of each patient were collected from the index date until December 2013. The incidence of corneal ulcer was compared between the two groups. In total, 2,549 patients with DM and 1,988 controls developed corneal ulcer during the follow-up period, resulting in an incidence rate for corneal ulcers that was 1.27 times (95% confidence interval [CI] = 1.20–1.35; P < 0.001) higher in patients with DM than in controls. After adjustment for potential confounders, including hyperlipidemia, hypertension, congestive heart failure, coronary artery disease, and chronic renal disease, patients with DM were 1.31 times (95% CI, 1.24–1.40; P < 0.05) more likely than the cohort to develop corneal ulcers. In conclusion, this study shows that DM increases the risk of corneal ulcer. Therefore, close collaboration between ophthalmologists and endocrinologists is important to ensure timely ophthalmology visits.
Highlights
The global increase in the prevalence of diabetes mellitus (DM) is an important public health burden related to its accompanying morbidity and mortality[1,2,3]
This study is the largest population-based study that has been conducted to explore the relationship between DM and subsequent corneal ulcer
Several studies have reported the occurrence of DM in patients with infectious keratitis
Summary
The global increase in the prevalence of diabetes mellitus (DM) is an important public health burden related to its accompanying morbidity and mortality[1,2,3]. Contact lens use is a major risk factor and the most common aetiology for the pathogenesis of corneal ulcers[10,11,12]. It may occur because of dry eyes resulting from an unbalanced and unstable tear film, compromised ocular surface associated with corneal epithelium abnormality, and ocular surface injury associated with decreased corneal sensitivity[7,8,9]. Decreased corneal sensitivity and abnormal neural regulation is known to result in delayed epithelial wound healing and increased risk of corneal ulcer following corneal trauma in patients with DM18.
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