| In diabetic patients,factors such as abnormal morphology and structure of the corneal epithelium,delayed healing after injury,abnormal corneal nerve morphology and decreased density,decreased corneal sensation,and decreased corneal resistance and repair ability cause a decline in the defensive ability of the corneal epithelium to resist pathogenic microorganisms,therefore it becomes easy for secondary infection caused by pathogenic microorganisms,such as bacteria and fungi to occur,leading to infectious keratopathy.In addition,diabetic patients often have persistent corneal epithelial defects after cataract surgery,vitreoretinal surgery,and corneal transplantation,which are likely to cause secondary infection of the cornea as well.Infectious keratopathy is the main blinding eye disease in China,and it is also a preventable blinding keratopathy.A more detailed study of the risk factors associated with clinical onset should be conducted as this will help more doctors and diabetic patients understand DK and recognize the risk factors for infectious keratopathy in diabetic patients,which in turn will aid the prevention of infectious keratopathy.This study was a retrospective analysis that compared the clinical data of patients with T2DM and non-diabetes mellitus(NDM),in order to investigate the risk factors of infectious keratopathy in T2DM patients.Furthermore,a new strategy for the prevention and treatment of infectious keratopathy in T2DM patients is proposed in the present study.Objective The purpose of this study was to analyse the incidence of infectious keratopathy in patients with T2DM and NDM,compare the clinical characteristics of infectious keratopathy in T2DM and NDM patients,and investigate the risk factors for infectious keratopathy in T2DM patients.Methods This was a retrospective study that included a total of 230 T2DM patients diagnosed with infectious keratopathy.They were selected from patients hospitalised at the Qingdao Eye Hospital in Shandong Eye Institute from 2001 to 2015,and 168NDM patients diagnosed with infectious keratopathy were randomly selected at the same time and included in the study.T2DM patients diagnosed with infectious keratopathy were categorized as the experimental group(diabetic group)whereas patients with NDM diagnosed with infectious keratopathy were categorized as the control group(non-diabetic group).General data including sex,age,occupation,season of onset,smoking and alcohol consumption habits,inducement disease duration,and hospitalisation data,including pathogenic microorganisms of corneal infection,treatments,and duration of hospitalization were collected,all collated data were then statistically analysed.The meaningful indicators of general data were included in the multivariate logistic regression analysis,and the difference between the two groups was compared.In addition,infectious keratopathies were divided into herpes simplex keratitis(HSK),bacterial keratitis(BK),fungal keratitis(FK)and acanthamoeba keratitis(AK),and statistical analysis was performed to compare the differences in various corneal infections between the diabetic and non-diabetic groups.Results The diabetic group consisted of 146(63.5%)males and 84(36.5%)females.The NDM group consisted of 111(66.1%)males and 57(33.9%)females.There was no significant difference in sex distribution,smoking,alcohol consumption habits and inducement between the two groups(P>0.05).The age of patients in the diabetic group was significantly higher than that of the patients in the non-diabetic group(t=-2.352,P<0.05).There were significant differences in age groups,occupation,season of onset,and disease duration between the two groups(P<0.05).For most of the patients in the diabetic group,the disease duration was<3 months whereas the disease duration was>3 months for most patients in the NDM group.The average duration of hospitalization for diabetic patients was 13.15±9.51 days whereas that of non-diabetic patients was 10.67±6.23 days,there was a significant difference between the two groups(P<0.05).There were significant differences in treatment between the two groups(P<0.05)as well.Meaningful indicators of general data analysis were substituted for a multivariate logistic regression model.Multivariate logistic regression analysis revealed that age and season of onset were related to the development of infectious keratopathy in the T2DM group.There were statistically significant differences in the incidences of BK and HSK between the two groups(P<0.05),but no statistically significant difference was found between the incidence of FK and that of AK(P>0.05).Conclusion Advanced age and the summer and winter seasons are identified as risk factors for infectious keratopathy in T2DM patients.Compared with non-diabetic patients,T2DM patients are more prone to BK.For T2DM patients of advanced age,attention should be paid to ocular hygiene and ocular trauma should be avoided,especially in summer and winter seasons,to prevent the occurrence of infectious keratopathy.T2DM patients have a short disease duration and a long average duration of hospitalization.Glycosylated hemoglobin Ale(HbAlc)is used as a criterion for the diagnosis of DM.HbAlc can reflect the patient's blood glucose control level over a period of 8—12weeks.It has little biological variability,is not susceptible to blood glucose fluctuation,and is not influenced by the use of insulin and other factors.Short-term increase or decrease in blood glucose does not cause the increase or decrease of HbAlc,therefore,the HbAlc level of a diabetic patient can provide more comprehensive information on the glycaemic control level in the aforementioned period of time.The main clinical manifestation of DK is prone to long-term defects of the corneal epithelium,and the protective barrier of the corneal epithelium is destroyed,thus making the cornea vulnerable to secondary infection.This chapter focuses on examining the HbAlc and blood glucose levels in T2 DM patients who develop infectious keratopathy and determining the possible differences in the specific methods for the treatment of herpes simplex keratitis,bacterial keratitis,fungal keratitis,and acanthamoeba keratitis between diabetic and non-diabetic patients.Objective This study aimed to compare HbAlc and blood glucose levels in T2 DM and NDM patients with infectious keratopathy,to investigate the effects of HbAlc and blood glucose levels on infectious keratopathy,and to analyse the differences in the treatment of infectious keratopathy between T2 DM and NDM patients.Methods This was a retrospective study that included 230 T2 DM patients diagnosed with infectious keratopathy(diabetic group).They were selected from patients hospitalized at the Qingdao Eye Hospital in Shandong Eye Institute from 2001 to2015,168 NDM patients diagnosed with infectious keratopathy were randomly selected at the same time(non-diabetic group)and were included in the study as well.The fasting blood glucose records of the two groups were collected,the blood glucose value measured two hours after three meals,and the HbAlc data of the patients in the diabetic group were also collected.The treatment methods for the patients were divided into drug treatment and surgical treatment.Surgical treatment was divided into corneal ulcer debridement conjunctival flap covering,amniotic membrane transplantation,corneal ulcer debridement plus conjunctival flap covering,corneal ulcer debridement plus amniotic membrane transplantation,blepharoplasty,amniotic membrane transplantation plus blepharoplasty,lamellar keratoplasty(LKP),penetrating keratoplasty(PKP),LKP plus blepharoplasty,PKP plus conjunctival flap covering,PKP plus blepharoplasty,enucleation of eye contents and enucleation of the eyeball.Results In the diabetic group,the mean fasting blood glucose value was 8.2±3.5mmol/L,and the range of blood glucose fluctuation was 6.0± 1.8—10.3±3.4mmol/L.In the non-diabetic group,the mean fasting blood glucose value was 5.3±0.5 mmol/L.There was a significant difference in the fasting blood glucose values between the two groups(P<0.05).In the diabetic group,the mean blood glucose level measured two hours after three meals was 12.2±6.7 mmol/L,and the range of blood glucose fluctuation was 6.7±3.1—17.8±4.3 mmol/L,the average blood glucose level measured two hours after three meals in the diabetic patients was significantly higher than 7.8 mmol/L,there was significant difference(P<0.05).The mean HbAlc level of the diabetic patients was 9.1 ±2.1 %,which was significantly higher than 6.50/0,there was significant difference(P<0.05).Among the various treatment methods for patients in the diabetic group,bacterial keratitis and herpes simplex keratitis were mostly treated with drugs,the proportion of patients that were treated was 40.5% and45.5%.respectively.Fungal keratitis was mostly treated with PKP(38.5%).Enucleation of eye contents was performed for two cases of acanthamoeba keratitis.Regarding the various treatments performed for patients in the non-diabetic group,bacterial keratitis and herpes simplex keratitis were mostly treated with drugs,the proportion of patients that were treated was 42.2% and 63.6%,respectively.Drug treatment(32.6%)and corneal ulcer debridement(30.2%)were the most common treatments for fungal keratitis.Three cases of acanthamoeba keratitis were treated with drugs.Enucleation of eye contents or enucleation of the eyeball was performed for 14 patients in the diabetic group whereas none of the non-diabetic patients underwent enucleation of eye contents or enucleation of the eyeball.Most diabetic patients with infectious keratopathy only took oral hypoglycaemic drugs(64.3%),and their glycaemic control level was poor.Conclusion Fasting blood glucose,blood glucose measured two hours after three meals,and HbAIc levels were significantly increased in T2 DM patients with infectious keratopathy.In both groups,bacterial keratitis was treated similarly to herpes simplex keratitis,and most cases were treated with drugs.For fungal keratitis,PKP was the most common mode of treatment in the diabetic group whereas the non-diabetic patients were most commonly treated with drugs and comeal ulcer debridement.Poor glycaemic control levels and high fluctuations may have a certain impact on the choice of treatment methods for infectious keratopathy.T2DM patients with infectious keratopathy require more standardized glycaemic control therapy. |
PDF Full Text Request