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J.-J. Lee, H.-K. Kuo, Y.-J. Chen; The Risk Factors of Endogenous Endophthalmitis in Patients With Diabetes Mellitus. Invest. Ophthalmol. Vis. Sci. 2008;49(13):967.
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To evaluate the risk factors associated the attack of endogenous endophthalmitis in patients with diabetes mellitus.
We retrospectively review medical record of 1999 to 2006 to conduct a age and sex matched case-control study that collected 29 diabetic patients with an attack of endogenous endophthalmitis (EE) to compare factors of (1) duration of diabetic history, (2) levels of diabetic control (HbA1c), (3) body mass index (BMI), (4) prevalence of hypertension, dyslipidemia, macrovascular complications, advanced nephropathy, diabetic neuropathy, and proliferative retinopathy with the 87 diabetic patients without a history of endophthalmitis (control group) from our metabolic and endocrine department. SPSS 10.0 is used for calculation in statistics.
The mean age of patients is 52.5 years. Sixteen women (55%) and 13 men (45%) EE patients are included. Nearly 40% of EE were accompanied by liver involvement and the leading pathogen is Klebsella pneumoniae (66%). The EE group had a shorter history of diabetes mellitus (4.2 vs. 8.4 years, 95% CI of difference is 1.25 to 7.06 years, p=0.006) and a relatively poor blood sugar control indicated by levels (%) of HbA1c (10.71 vs. 8.40, 95% CI of difference is 1.28 to 3.62, p<0.001) when compared to the control group. The differences of BMI and prevalence of diabetes associated complications between groups are insignificant. However, in addition to poor sugar control (odd ratio 1.67 for every 1% increase of HbA1c, p<0.001), diabetic neuropathy is also identified to be associated with EE (odd ratio 4.15, p=0.03) after adjust for the duration of diabetic history in binary logistic regression. Most EE patients (89.4%) had no proliferative diabetic retinopathy in the fellow eye, comparable to the prevalence in control group (87.4%, p=1.00).
This study provides the preliminary evidence to correlate poor sugar control with the attack of endogenous endophthalmitis in diabetic patients. A majority of patients underwent EE have a relatively short diabetic history and no diabetic associated late complications such as diabetic retinopathy. The role of neuropathy in the pathogenesis of EE required further sophisticated study to clarify. To prevent the vision-destructive catastrophe of EE, early recognition of diabetes mellitus and regular blood sugar control are the most important tasks for health care professionals.
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