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New research · Ophthalmology
International ophthalmology · 1d
Cohort studyInternational ophthalmology · 2026

Association of obstructive sleep apnea and continuous positive airway pressure on risk of corneal ulceration and surgical interventions.

Nicholas Stratigakis, Michael Kozlov, Robert Adler … Jennifer Park
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OphthalmologyCohort study

Continuous positive airway pressure is associated with lower rates of keratoplasty in obstructive sleep apnea.

Association of obstructive sleep apnea and continuous positive airway pressure on risk of corneal ulceration and surgical interventions.

Nicholas Stratigakis et al. · International ophthalmology · 2026
Purpose

To evaluate whether obstructive sleep apnea (OSA) is associated with corneal ulceration and surgical intervention, and to assess the impact of continuous positive airway pressure (CPAP) therapy on these outcomes.

Methods

This retrospective cohort study used data from the TriNetX electronic health record database.

n = 287,572
Results

Continuous positive airway pressure treatment is linked to a lower risk of needing corneal transplant surgery

RR by subgroup · 95% CI
null = 1
incidence of corneal ulcer
1.18
perforated corneal ulcer
3.99
keratoplasty
1.56
incidence of perforated corneal ulcer
0.73
keratoplasty
0.66
More results

OSA was associated with higher incidence of corneal ulcer (0.98% vs 0.83%; RR 1.183, 95%CI 1.120-1.249), perforated corneal ulcer (0.15% vs 0.04%; RR 3.992, 95%CI 3.243-4.915), and keratoplasty (RR 1.556, 95%CI 1.427-1.696).

Compared to controls, CPAP-treated OSA patients remained at elevated risk of corneal ulceration and surgical intervention.

“
Conclusion · 1 of 2

OSA was associated with higher incidence of corneal ulceration, severe ulcer-related sequelae, and corneal surgical interventions.

Conclusion · 2 of 2

CPAP was associated with fewer severe ulcer complications and reduced keratoplasty utilization, but higher dry eye burden. CPAP was associated with reduced but persistent ocular risk in patients with OSA.

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