Herpetic eye disease in diabetic patients

Purpose: To study the incidence of herpetic eye disease (HED) of the ocular surface in diabetics. Design: Observational historical cohort study. Setting: A district of the largest health maintenance organization in Israel (the Central District of Clalit Health Services). Participants: We reviewed the electronic medical records of all patients older than 50 years (159634 patients) in the district, and of these, 22382 (14.0%) patients had diabetes mellitus. Methods: All filled prescriptions for acyclovir eye ointment between January 1, 2001 and December 31, 2003 (1483 tubes) and all hemoglobin A_1c laboratory tests during 2003 (41910 tests) were documented. An ocular surface HED event was defined when a patient consumed at least 1 tube of topical acyclovir per month, whereas no acyclovir use was documented 3 months before and 3 months after that event. Main Outcome Measures: Incidence of ocular surface HED events in diabetics compared with nondiabetics adjusted for age and gender. Results: After age and gender adjustment, significantly more diabetics had ocular surface HED (5.21‰) compared with nondiabetics (4.27‰; P<0.0001). Stratification by age revealed a significantly higher prevalence of HED in diabetics, aged 60 to 79 years. Recurrent herpetic events occurred during the study period in 25.2% of HED-affected diabetics, and in 16.6% of HED-affected nondiabetics (P = 0.05). Diabetics with poor glycemic control (mean annual hemoglobin A_1c > 9%) consumed significantly more ocular acyclovir (P = 0.01). Multivariate analysis revealed this effect to be independent of age, gender, place of birth, or place of residency. Conclusions: Ocular surface HED is significantly more common among patients with diabetes mellitus. Poor glycemic control correlates with increased consumption of ocular acyclovir in diabetic patients.