Corneal endothelium and central corneal thickness changes in type 2 diabetes mellitus

Amira El-Agamy, Shams Alsubaie, Amira El-Agamy, Shams Alsubaie

Abstract

Purpose: This study was conducted to compare the corneal endothelial cell density (ECD), morphological features, and central corneal thickness (CCT) in type 2 diabetes mellitus (DM) with age-matched, nondiabetic control subjects using EM-3000 Specular Microscope.

Study design: This was a prospective, hospital-based, nonrandomized, case-control, observational, and quantitative study.

Subjects and methods: The study included 57 patients (57 eyes) with type 2 DM and 45 control (nondiabetic) subjects (45 eyes). The corneal endothelial structure and CCT were examined in all eyes by noncontact specular microscopy using EM-3000 Specular Microscope. The endothelial structure was studied for ECD, coefficient of variation of cell area (CV), and percentage of hexagonal cells.

Results: The study included 36 eyes without diabetic retinopathy (DR), 14 eyes with nonproliferative DR, and 7 eyes with proliferative DR. There were 26 eyes with a duration of ≤10 years and 31 eyes with a duration of >10 years. Also, there were 24 eyes with HbA1c ≤7.5% and 33 eyes with HbA1c >7.5%. ECD was significantly lower in the diabetic cornea than in control group (P=0.014). CV was higher in diabetic cornea (P=0.008). The diabetic cornea group had lower percentage of hexagonal cells than the control group, but the difference was not statistically significant (P=0.603). Also, diabetic cornea was thicker than control group, but not statistically significant (P=0.301).

Conclusion: This study documented that type 2 DM causes a significant reduction of ECD and increased CV (polymegathism). Also, diabetic cornea has increased CCT and lower percentage of hexagonal cells than normal subjects, but without statistical significance.

Keywords: central corneal thickness; diabetes mellitus; diabetic retinopathy; endothelial cell density; noncontact specular microscopy.

Conflict of interest statement

Disclosure Dr Amira El-Agamy is financially supported by the Research Center of College of Applied Medical Sciences, King Saud University, Saudi Arabia. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Corneal endothelium picture taken by EM-3000 Specular Microscope (CBD/Tomey, Phoenix, AZ, USA) for non-DM female (46 years old). Abbreviation: DM, diabetes mellitus.
Figure 2
Figure 2
Corneal endothelium picture taken by EM-3000 Specular Microscope (CBD/Tomey, Phoenix, AZ, USA) for DM female (46 years old) with PDR (DM duration of 20 years and HbA1c =9.2%). Abbreviations: DM, diabetes mellitus; HbA1c, glycated hemoglobin; PDR, proliferative diabetic retinopathy.
Figure 3
Figure 3
Corneal endothelium picture taken by EM-3000 Specular Microscope (CBD/Tomey, Phoenix, AZ, USA) for non-DM male (58 years old). Abbreviation: DM, diabetes mellitus.
Figure 4
Figure 4
Corneal endothelium picture taken by EM-3000 Specular Microscope (CBD/Tomey, Phoenix, AZ, USA) for DM male (56 years old) without DR (DM duration of 8 years and HbA1c =9.5%). Abbreviations: DM, diabetes mellitus; DR, diabetic retinopathy; HbA1c, glycated hemoglobin.

References

    1. Herse PR. A review of manifestations of diabetes mellitus in the anterior eye and cornea. Am J Optom Physiol Optics. 1988;65:224–230.
    1. Thomas N, Jeyaraman K, Asha HS, Velevan J. A Practical Guide to Diabetes Mellitus. New Delhi, India: Jaypee Brothers Medical Publishers; 2012.
    1. Chawla R. Complications of Diabetes. New Delhi, India: Jaypee Brothers Medical Publishers; 2012.
    1. Choo M, Prakash K, Samsudin A, Soong T, Ramli N, Kadir A. Corneal changes in type II diabetes mellitus in Malaysia. Int J Ophthalmol. 2010;3(3):234–236.
    1. Sudhir R, Raman R, Sharma T. Changes in the corneal endothelial cell density and morphology in patients with type 2 diabetes mellitus: a population-based study, Sankara Nethralaya Diabetic Retinopathy and Molecular Genetics Study (SN-DREAMS, Report 23) Cornea. 2012;31(10):1119–1122.
    1. Storr-Paulsen A, Singh A, Jeppesen H, Norregaard J, Thulesen J. Corneal endothelial morphology and central thickness in patients with type II diabetes mellitus. Acta Ophthalmol. 2013;92(2):158–160.
    1. Guthrie DW, Guthrie R. Management of Diabetes Mellitus: A Guide to the Pattern Approach. 6th. New York, NY: Springer Publishing Company; 2008.
    1. World Health Organization . Definition, Diagnosis and Classification of Diabetes Mellitus and Its Complications. Geneva, Switzerland: World Health Organization; 1999. (Report of a WHO Consultation).
    1. Inoue K, Kato S, Inoue Y, Amano S, Oshika T. The corneal endothelium and thickness in type II diabetes mellitus. Jpn J Ophthalmol. 2002;46(1):65–69.
    1. Siribunkum J, Kosrirukvongs P, Singalavanija A. Corneal abnormalities in diabetes. J Med Assoc Thai. 2001;84(8):1075–1083.
    1. Shenoy R, Khandekar R, Bialasiewicz A, Al Muniri A. Corneal endothelium in patients with diabetes mellitus: a historical cohort study. Eur J Ophthalmol. 2009;19(3):369–375.
    1. Lee JS, Oum BS, Choi HY, Lee JE, Cho BM. Differences in corneal thickness and corneal endothelium related to duration in diabetes. Eye. 2006;20(3):315–318.
    1. Chen Y, Huang S, Jonna G, Channa P. Corneal endothelial cell changes in diabetes mellitus. Invest Ophthalmol Vis Sci. 2014;55(5):2054.
    1. Browning DJ. Diabetic Retinopathy: Evidence-Based Management. New York, NY: Springer; 2010.
    1. Tripathy BB, Chandalia HB, Das AK, Rao PV. Textbook of Diabetes Mellitus. New Delhi, India: Jaypee Brothers Medical Publishers; 2012.
    1. Altay Y, Burcu A, Ornek F. The change in central corneal thickness after successful control of hyperglycemia in diabetic patients. Int Eye Sci. 2014;14(4):575–578.
    1. Pardos GJ, Krachmer JH. Photocoagulation: its effect on the corneal endothelial cell density of diabetics. Arch Ophthalmol. 1981;99(1):84–86.

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir