Abstract
Purpose :
Doxycycline is a known treatment for meibomian gland disease (MGD), which is a major risk factor for the development of dry eye syndrome (DES) and recurrent corneal erosion (RCE). The degree to which pre-existing corneal conditions pose a risk for complications after keratorefractive surgery (KRS) is as yet undetermined. This study compared differences in outcomes in the 1-year postoperative period following KRS between patients with and without a 1-year history of doxycycline use.
Methods :
A retrospective cohort study was conducted using TriNetX, a real-time, national, federated research network. Patients who underwent KRS were identified by Current Procedural Terminology (CPT) code and stratified into two cohorts based on their history of doxycycline use. Each subject was then matched to a control via 1:1 propensity score matching based on age, gender, BMI, and medical comorbidities such as essential hypertension, diabetes mellitus, and chronic lower respiratory diseases. The primary endpoint of the study was the comparative 1-year postoperative incidence of the following outcomes: DES, RCE, secondary corneal edema, corneal scar or opacity, corneal ectasia, acute conjunctivitis, diffuse lamellar keratitis, corneal neovascularization, vitreous degeneration, ischemic optic neuropathy, vitreous hemorrhage, retinal detachment or break, retinal edema, and cystoid macular degeneration.
Results :
A total of 2,056 patients were included in the analysis with 1,028 patients in each cohort after propensity matching. The doxycycline cohort had a statistically significant higher risk of developing DES (RR 1.46, 95% CI 1.2-1.78; RD 6.32%, 95% CI 3.1-9.55) and RCE (RR 2.8, 95% CI 1.37-5.73; RD 1.75%, 95% CI 0.59-2.91) within 1 year of undergoing KRS compared to matched controls. No significant differences were detected between the two cohorts for the other 1-year postoperative outcomes.
Conclusions :
Dry eye syndrome and RCE are commonly seen in the postoperative period of KRS and can impact the quality of life in patients. In this study, patients with a history of doxycycline use were significantly more likely to develop DES and RCE following KRS. All other assessed clinical outcomes revealed no significant difference. The severity of pre-existing corneal conditions should be considered when evaluating patients for KRS and discussing outcomes with patients both pre- and post-operatively.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.