Predictors of visual acuity improvement in diabetic patients with retinal disease with corneal ulcer

Abstract

Background: Diabetic patients whose eyes carry both retinal disease and a corneal ulcer present a prognostic challenge, because an unstable corneal surface degrades measured acuity and constrains treatment tempo, while the systemic factors that predict poor corneal healing also predict a blunted retinal treatment response.

Objective: This review synthesizes evidence on predictors of visual acuity improvement in diabetic patients with retinal disease complicated by corneal ulcer, drawing on the retinal treatment-response literature and the corneal healing literature together.

Methods: We reviewed randomized trials and cohort studies of anti-VEGF and laser therapy for diabetic macular edema and proliferative diabetic retinopathy, alongside clinical and mechanistic studies of corneal ulcer risk and healing in diabetes, synthesizing the two literatures given the scarcity of studies enrolling patients with both diagnoses concurrently.

Findings: Baseline visual acuity, macular edema chronicity and structural integrity, and macular ischemia remain the dominant predictors of retinal treatment response; diabetes duration, glycemic control, and corneal sensory neuropathy predict corneal ulcer occurrence and healing speed; and an active ulcer functions as a modifier that transiently degrades measured acuity, delays retinal treatment scheduling, and marks a patient whose overall disease severity already limits the retinal treatment ceiling.

Conclusions: Prompt recognition and management of the corneal component allows retinal treatment to proceed on schedule and clarifies the eye's true visual potential once the surface stabilizes; routine ocular surface screening is warranted in diabetic patients with long disease duration, poor glycemic control, and advanced retinopathy.