Prevention of diabetic keratopathy

Patient morbidity related to diabetic induced ocular complications has increased year on year commensurate with the worldwide increase in the incidence of diabetes. These complications include retinopathy, neovascular glaucoma, optic neuropathy, keratopathy, and dry eye. Diabetic retinopathy, because of its clinical importance as a leading cause of blindness, has attracted the major thrust of both clinical and basic research. Clinical ophthalmological management of this condition now routinely includes photocoagulation and vitreoretinal surgery. Various systemic and local medications are now also being extensively examined both through basic research and clinical trials to determine their clinical efficacy in managing the complications of diabetic retinopathy.

Diabetic keratopathy has featured as the “poor relation” with regard to both clinical and research interest. The condition is not thought to represent a serious clinical or pathological entity and hence has been overlooked by both physician and scientist alike. Yet with only cursory investigation it is obvious that many patients have visual loss secondary to diabetic keratopathy. Diabetic keratopathy comprises several symptomatic corneal conditions inducing superficial punctate keratopathy and persistent corneal epithelial erosion.¹ The latter can be encountered especially after vitreoretinal surgery, where oedematous and cloudy corneal epithelium, often manually removed to restore clarity, results postoperatively in a poorly healing corneal epithelial surface. De novo epithelial erosion in diabetic patients can often be resistant to routine clinical management of corneal erosions including topical medication and bandage contact lenses. These poorly healing epithelial surfaces have compromised defences against general microbial attack, predisposing these patients to bacterial and fungal infective keratopathies.

Keratopathy in the presence of diabetes …