Insulin usage and glaucoma treatment associated with the incidence of surgically treated vision-threatening epiretinal membrane: Evidence from an epidemiological study.

Abstract

Purpose: Multiple factors play a role in epiretinal membrane (ERM) formation and appear to affect the risk of ERM surgery. We explored whether the use of common systemic and topical medications is associated with ERM surgery in Finland.

Methods: The main outcome variable was incidence of surgically treated vision-threatening epiretinal membrane (NOMESCO codes CKD91, 92, 94). The population-based historic cohort consisted of participants whose follow-up was started 2000. The main exposures of interest were Anatomical Therapeutic Chemical (ATC) codes: A10A (INSULINS AND ANALOGUES), A10B (BLOOD GLUCOSE-LOWERING DRUGS, excluding INSULINS), C10AA (HMG CoA reductase inhibitors) and S01 (OPHTHALMOLOGICALS) initiated during 2001-2010. We constructed a nested case-control (NCC) design with conditional logistic regression taking matching by sex and year of birth with calibre of 1 year into account and used NCC incident density sampling. Results are presented as odds ratios (OR) with 95% confidence intervals (CIs).

Results: Our cohort involved 2165 ERM cases undergoing surgery on any eye and 10 825 age-matched controls who did not undergo surgery (five for each case). In univariate analysis, the use of insulins and analogues (adjusted OR, 1.39 [95% CI, 1.24-1.56]) and blood glucose-lowering drugs (1.25, 1.02-1.53) were associated with an increased risk for ERM surgery. In multivariate analysis, the risk remained high in insulin users (1.67, 1.46-1.91) and in patients using any glaucoma medication (2.71, 2.30-3.19).

Conclusions: Our study demonstrates registry-based associations between insulin use, glaucoma therapies and ERM surgery. These findings do not support a causal link.