Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Palm Beach Gardens, Florida.
Ophthalmology. 2024 Jul;131(7):827-835. doi: 10.1016/j.ophtha.2024.01.016. Epub 2024 Jan 10.
To assess the correlation between primary open-angle glaucoma (POAG) and the risk of developing diabetic retinopathy (DR) in patients with type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM).
A retrospective cohort study leveraging the global patient database of TriNetX Research Network.
The study included 44 359 patients with diabetes mellitus (DM) with POAG and 4 393 300 patients with DM without any glaucoma ≥ 18 years of age. Propensity score matching harmonized the cohorts to 39 680 patients each, covering diagnoses from January 1, 2005, to January 1, 2023.
We analyzed data using specific International Classification of Diseases, 10 Revision (ICD-10) codes for DM and glaucoma. We matched the cohorts using propensity score matching, adjusting for age, sex, race/ethnicity, blood markers, relevant medical history, and ophthalmic service use.
The primary outcome was the first-time occurrence of DR, including nonproliferative DR (NPDR) and proliferative DR (PDR), in patients with DM with and without glaucoma at 1-, 5-, and 10-year intervals from their individual index dates.
At 10 years, patients with T1DM with POAG exhibited a heightened risk for any DR (adjusted risk ratios [RRs], 4.12; 95% confidence interval [CI], 3.05-5.57, P < 0.0001) and PDR (RR, 7.02; 95% CI, 3.62-13.61, P < 0.0001). Patients with T2DM and POAG also faced an increased 10-year risk for any DR (RR, 2.47; 95% CI, 2.28-2.68, P < 0.0001) and PDR (RR, 3.82; 95% CI, 3.09-4.70, P < 0.0001). The combined association of POAG on DR risk in those with T1DM and T2DM at 10 years was found to be significantly higher among patients with POAG (5.45%) compared with those without glaucoma (2.12%) (adjusted hazard ratio [aHR], 2.33; 95% CI, 2.14-2.53). The cumulative incidence of DR was significantly higher in the POAG group compared with nonglaucoma counterparts after a decade (log-rank P < 0.001).
Our findings underscore a substantial association between POAG and DR development in both T1DM and T2DM patients, emphasizing the need for vigilant screening and comprehensive management in glaucomatous patients with DM to mitigate the risk of DR. Future research should delve into elucidating the causal mechanisms driving these observed associations.
FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
评估原发性开角型青光眼（POAG）与 1 型糖尿病（T1DM）和 2 型糖尿病（T2DM）患者发生糖尿病视网膜病变（DR）风险之间的相关性。
利用 TriNetX 研究网络的全球患者数据库进行回顾性队列研究。
该研究纳入了 44359 例患有糖尿病（DM）合并 POAG 的患者和 4393300 例患有任何 DM 但无任何青光眼的患者（≥18 岁）。采用倾向评分匹配使队列达到一致，每组均有 39680 例患者，涵盖了 2005 年 1 月 1 日至 2023 年 1 月 1 日的诊断。
我们使用特定的国际疾病分类第 10 版（ICD-10）代码分析 DM 和青光眼的数据。我们使用倾向评分匹配对队列进行匹配，根据年龄、性别、种族/民族、血液标志物、相关病史和眼科服务使用情况进行调整。
主要结局是 DM 合并和不合并青光眼的患者在各自的指数日期后 1、5 和 10 年间隔内首次发生 DR（包括非增殖性 DR（NPDR）和增殖性 DR（PDR））。
在 10 年内，患有 T1DM 合并 POAG 的患者发生任何 DR（校正风险比 [RR]，4.12；95%置信区间 [CI]，3.05-5.57，P<0.0001）和 PDR（RR，7.02；95% CI，3.62-13.61，P<0.0001）的风险显著升高。患有 T2DM 合并 POAG 的患者在 10 年内发生任何 DR（RR，2.47；95% CI，2.28-2.68，P<0.0001）和 PDR（RR，3.82；95% CI，3.09-4.70，P<0.0001）的 10 年风险也增加。发现 T1DM 和 T2DM 合并 POAG 患者在 10 年内发生 DR 的联合风险显著高于无青光眼的患者（5.45%比 2.12%）（校正危害比[aHR]，2.33；95% CI，2.14-2.53）。在十年后，POAG 组的 DR 累积发生率明显高于非青光眼对照组（对数秩 P<0.001）。
我们的研究结果强调了 POAG 与 T1DM 和 T2DM 患者 DR 发展之间存在显著关联，这表明在患有 DM 的青光眼患者中需要进行警惕性筛查和全面管理，以降低 DR 的风险。未来的研究应深入阐明导致这些观察到的关联的因果机制。
作者在本文讨论的任何材料中均无专有的或商业利益。
