Kuo Irene C, Broman Aimee, Pirouzmanesh Ashkan, Melia Michele
Wilmer Eye Institute and Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21236, USA.
Ophthalmology. 2006 Feb;113(2):184-90. doi: 10.1016/j.ophtha.2005.10.009. Epub 2005 Dec 20.
To examine whether there is an association between diabetes mellitus (DM) and keratoconus.
A retrospective comparison of the proportion of keratoconus patients with DM versus the proportion of overall patients with DM, and a retrospective cross-sectional study of a cohort consisting of all diabetic keratoconus patients and randomly selected keratoconus patients without DM at a single center.
Patients seen at the Wilmer Eye Institute from January 1, 1995, through March 18, 2004.
Review of billing data and clinic charts. Eligibility criteria for the cross-sectional study were 1 or more clinic visits, lack of other eye pathologic features (excluding cataract and diabetic retinopathy), and absence of bilateral penetrating keratoplasty (PK) at presentation. Application of novel keratoconus severity index was based on best-corrected visual acuity (BCVA) in the better eye at last visit and defined as: grade 1 (least severe), spectacle wear with BCVA of 20/40 or better; grade 2 (intermediate), spectacle wear with BCVA worse than 20/40 or rigid gas permeable lens wear; grade 3 (most severe), PK.
Prevalence of DM in keratoconus patients and those without keratoconus, odds ratio of having DM on a diagnosis of more severe keratoconus, and prevalence of DM in keratoconus patients and those without keratoconus who underwent corneal transplantation.
There was no difference in the prevalence of DM in keratoconus patients and those without keratoconus, and there was no difference in the prevalence of DM in keratoconus patients and those without keratoconus undergoing PK. However, our results suggest a negative association between DM and severity of keratoconus (P = 0.03, Fisher exact test). The odds of being in the most severe group as opposed to the least severe group were lower in DM patients than in those without DM (P = 0.01; odds ratio [OR] = 0.20; 95% confidence interval [CI], 0.05-0.70). Compared with those without DM, DM patients also had lower odds of being in the intermediate group than in the least severe group (P = 0.02; OR = 0.25; 95% CI, 0.08-0.80). After adjustment for age, gender, and race, these differences remained statistically significant.
We found that DM is not associated with a diagnosis of keratoconus, but having DM decreases the odds of having more severe keratoconus.
研究糖尿病（DM）与圆锥角膜之间是否存在关联。
对圆锥角膜患者中患DM的比例与全体患者中患DM的比例进行回顾性比较，并对一个队列进行回顾性横断面研究，该队列由单一中心的所有糖尿病圆锥角膜患者和随机选取的无DM的圆锥角膜患者组成。
1995年1月1日至2004年3月18日在威尔默眼科研究所就诊的患者。
审查计费数据和临床图表。横断面研究的纳入标准为1次或更多次门诊就诊、无其他眼部病理特征（不包括白内障和糖尿病视网膜病变）且就诊时无双侧穿透性角膜移植术（PK）。新型圆锥角膜严重程度指数的应用基于最后一次就诊时较好眼的最佳矫正视力（BCVA），定义为：1级（最不严重），佩戴眼镜且BCVA为20/40或更好；2级（中度），佩戴眼镜且BCVA低于20/40或佩戴硬性透气性角膜接触镜；3级（最严重），PK。
圆锥角膜患者和非圆锥角膜患者中DM的患病率、诊断为更严重圆锥角膜时患DM的比值比，以及接受角膜移植的圆锥角膜患者和非圆锥角膜患者中DM的患病率。
圆锥角膜患者和非圆锥角膜患者中DM的患病率无差异，接受PK的圆锥角膜患者和非圆锥角膜患者中DM的患病率也无差异。然而，我们的结果提示DM与圆锥角膜严重程度之间存在负相关（P = 0.03，Fisher精确检验）。与非DM患者相比，DM患者处于最严重组而非最不严重组的几率更低（P = 0.01；比值比[OR] = 0.20；95%置信区间[CI]，0.05 - 0.70）。与非DM患者相比，DM患者处于中度组而非最不严重组的几率也更低（P = 0.02；OR = 0.25；95% CI，0.08 - 0.80）。在对年龄、性别和种族进行校正后，这些差异仍具有统计学意义。
我们发现DM与圆锥角膜的诊断无关，但患有DM会降低患更严重圆锥角膜的几率。
