Kosker Mustafa, Suri Kunal, Hammersmith Kristin M, Nassef Ahmad H, Nagra Parveen K, Rapuano Christopher J
Cornea Service, Wills Eye Hospital, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA.
Cornea. 2014 Aug;33(8):774-9. doi: 10.1097/ICO.0000000000000167.
The aim of this study was to evaluate the association between diabetes mellitus (DM) and keratoconus.
We conducted 2 substudies: (1) Retrospective comparison of the prevalence of DM in patients with keratoconus with that of control patients without keratoconus and (2) Cross-sectional study of the severity of keratoconus in diabetic keratoconus-affected patients and nondiabetic keratoconus-affected patients. Patients seen at the Wills Eye Hospital Cornea Service from January 2008 to August 2012 were included. Study 1 included 1377 patients with keratoconus and 4131 controls without keratoconus. Study 2 involved 75 type 2 diabetic keratoconus-affected patients and 225 nondiabetic keratoconus-affected patient, excluding patients with bilateral keratoplasty. In patients with a history of a corneal transplant in 1 eye, the other eye was included. Keratoconus severity was based on the topographic mean keratometry in the more severely affected eye.
Two of 1377 (0.15%) keratoconus-affected patients had type 1 DM, which was similar to that of 20 of the 4131 (0.49%) matched controls (P = 0.139). The prevalence of type 2 DM was higher in patients with keratoconus (93/1377, 6.75%) than in matched controls (200/4131, 4.84%) (P = 0.005). When categorized by age group, the prevalence of type 2 DM was higher in patients with keratoconus than in those without keratoconus in patients aged between 25 and 44 years (P = 0.036) and 45 and 64 years (P = 0.047). Using multinomial logistic regression analyses, the probability/risk of being in the severe keratoconus-affected group as opposed to the mild keratoconus-affected group was higher in patients with DM than in those without DM (P = 0.006; odds ratio = 2.691; 95% confidence interval, 1.330-5.445).
There may be a positive association between type 2 DM and the presence and severity of keratoconus.
本研究旨在评估糖尿病（DM）与圆锥角膜之间的关联。
我们进行了两项子研究：（1）回顾性比较圆锥角膜患者与无圆锥角膜的对照患者中DM的患病率；（2）对糖尿病圆锥角膜患者和非糖尿病圆锥角膜患者的圆锥角膜严重程度进行横断面研究。纳入2008年1月至2012年8月在威尔斯眼科医院角膜科就诊的患者。研究1纳入了1377例圆锥角膜患者和4131例无圆锥角膜的对照者。研究2纳入了75例2型糖尿病圆锥角膜患者和225例非糖尿病圆锥角膜患者，排除双眼角膜移植患者。对于有一只眼有角膜移植史的患者，纳入另一只眼。圆锥角膜严重程度基于受影响更严重眼的地形图平均角膜曲率。
1377例圆锥角膜患者中有2例（0.15%）患有1型DM，这与4131例匹配对照者中的20例（0.49%）相似（P = 0.139）。圆锥角膜患者中2型DM的患病率（93/1377，6.75%）高于匹配对照者（200/4131，4.84%）（P = 0.005）。按年龄组分类时，25至44岁（P = 0.036）和45至64岁（P = 0.047）的圆锥角膜患者中2型DM的患病率高于无圆锥角膜的患者。使用多项逻辑回归分析，与轻度圆锥角膜患者相比，DM患者属于重度圆锥角膜患者组的概率/风险更高（P = 0.006；优势比 = 2.691；95%置信区间，1.330 - 5.445）。
2型DM与圆锥角膜的存在及严重程度之间可能存在正相关。
