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Sarah Tanaka, Sahar Kohanim; Risk factors for development of corneal ulceration among patients with exposure keratopathy in the intensive care unit. Invest. Ophthalmol. Vis. Sci. 2016;57(12):6209.
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© ARVO (1962-2015); The Authors (2016-present)
Corneal ulceration due to exposure keratopathy (EK) is a potentially vision-threatening yet preventable ocular complication among patients in the intensive care unit (ICU). The aim of our study was to identify significant risk factors for development of corneal ulcer in ICU patients with EK.
We performed a retrospective cohort study using clinical data from Vanderbilt’s Synthetic Derivative database, which contains de-identified patient records. The study period ranged from 1998 to 2015. 130 ICU patients with documented EK were included. The outcome of interest was the development of corneal ulceration. Covariates of interest included use of mechanical ventilation, sedation, neuromuscular blockade, length of ICU or hospital stay, admitting diagnosis, ocular comorbidities, and length of time to initial ophthalmic consultation. Bivariate analysis was used to assess associations between covariates and outcomes. Multivariable logistic regression evaluated independent effects of covariates on the development of corneal ulceration.
53/130 patients (40.7%) developed a corneal ulcer. 121/130 patients (93.1%) had required mechanical ventilation with a median (IQR) duration of 13 (5-23) days, however neither the use of mechanical ventilation nor the duration of ventilation was associated with corneal ulcer development in this cohort. Trauma (47.7%) and neurological diagnoses (40.8%) were the most common admission diagnoses across groups. Orbital fracture was the most common ocular comorbidity (26.1%). In bivariate analysis, orbital fractures were marginally protective against ulcer development (OR 0.43; p=0.052). On multivariable analysis, having a neurologic admitting diagnosis was the only statistically significant risk factor for the development of corneal ulcer in ICU patients with EK when controlling for other covariates (adjusted OR 2.93, 95% CI 1.37-6.27; p<0.001).
While the majority of patients with EK received mechanical ventilation, mechanical ventilation was not a predictor of subsequent corneal ulcer development. ICU admission for a neurological diagnosis was the only significant independent risk factor for the development of corneal ulceration in our cohort. Further research is needed to clarify the underlying reasons for this association and to identify interventions to mitigate this risk.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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