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Association between atopic keratoconjunctivitis and the risk of corneal ulcer
  1. Ren-Long Jan1,2,
  2. Shih-Feng Weng3,
  3. Jhi-Joung Wang4,5,6,
  4. Sung-Huei Tseng7,8,
  5. Yuh-Shin Chang2,7
  1. 1 Department of Pediatrics, Chi Mei Medical Center, Liouying, Tainan, Taiwan
  2. 2 Graduate Institute of Medical Sciences, College of Health Sciences, Chang Jung Christian University, Tainan, Taiwan
  3. 3 Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan
  4. 4 Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan
  5. 5 Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
  6. 6 AI Biomed Center, Southern Taiwan University of Science and Technology, Tainan, Taiwan
  7. 7 Department of Ophthalmology, Chi Mei Medical Center, Tainan, Taiwan
  8. 8 Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
  1. Correspondence to Yuh-Shin Chang Department of Ophthalmology, Chi Mei Medical Center, 901 Zhonghua Rd, Yongkang District, Tainan 71004, Taiwan; yuhshinchang{at}


Aims To investigate the risk of corneal ulcer in patients with atopic keratoconjunctivitis (AKC).

Methods The nationwide, population-based, retrospective, matched cohort study included 171 019 newly diagnosed patients with AKC who were identified by the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), code 372.05, and selected from the Taiwan National Health Insurance Research Database. The age-, sex- and potential comorbidities-matched control group included 171 019 patients with non-AKC selected from the Taiwan Longitudinal Health Insurance Database 2000. Patient information was collected between 1 January 2004 and 31 December 2011, and both groups of patients were tracked from the index date until December 2013. The incidence and risk of corneal ulcer (ICD-9-CM code 370.0 except for 370.07) was compared between the groups. A Cox proportional hazard regression analysis was performed to obtain the adjusted HR for corneal ulcer. The cumulative corneal ulcer incidence rate was calculated with the Kaplan-Meier analysis.

Results In total, 2018 patients with AKC and 1481 controls developed a corneal ulcer during the follow-up period. The incidence rate of corneal ulcer was 1.42 times (95% CI1.33 to 1.52; p<0.0001) higher in patients with AKC than in controls. After adjusting for potential confounders, including diabetes mellitus, chronic renal disease, topical steroid ophthalmic agent use, lid margin disease, keratoconjunctivitis sicca, ocular blunt trauma and post-corneal transplantation, patients with AKC were 1.26 times more likely to develop a corneal ulcer than controls (adjusted HR, 1.26; 95% CI 1.14 to 1.39; p<0.05).

Conclusions Patients with AKC had an increased risk of developing a corneal ulcer and should be advised of this risk.

  • Cornea
  • Epidemiology
  • Ocular surface

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  • Contributors All authors conceived the study. R-LJ, S-FW, S-HT and Y-SC conducted the study. R-LJ, S-FW and Y-SC analysed the results and wrote the article. J-JW provided materials. All authors reviewed the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplemental information.

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