Diabetic Retinopathy as a Potential Risk Factor for Ptosis: A 13-Year Nationwide Population-Based Cohort Study in Taiwan

Background: To investigate whether patients with diabetic retinopathy (DR) or other possible clinical factors are at increased risk of ptosis.Methods: Data was collected from the Taiwan National Health Insurance system and included patients newly diagnosed with DR between 2000 and 2012. The endpoint of interest was a diagnosis of ptosis.Results: Follow-up data of 9,494 patients with DR and 37,976 matched comparisons (non-DR) from 2000 to 2012 were analyzed. Patients with DR were found to have a significantly higher cumulative incidence of ptosis (Kaplan-Meier analysis, log-rank test p < 0.001). With Cox regression analysis, the DR group was found to have higher risk of developing ptosis (adjusted hazard ratio (HR) [95% CI]: 2.76 [1.74-4.38], p < 0.001) when compared to the control cohort. Higher risks of developing ptosis in patients with DR were found in female patients and in adult patients of all age groups. When stratified by comorbidities, the influence of DR was more prominent for non-smokers. Patients with DR had a higher risk of developing ptosis compared to matched controls, regardless of whether they had lipid metabolism disorders and hypertension.Conclusions: Patients with DR were found to have higher risk of developing ptosis in this cohort study. Thus, patients with DR should be vigilant for symptoms of ptosis. For female patients, adult patients, or patients without smoking, the association of DR with ptosis development is even stronger. Before ptosis surgery, the possibility of underlying diabetes or DR should be also scrutinized and treated properly to avoid undesirable postoperative dissension.