Assessment of Corneal Endothelium among Diabetic Patients in a Multispecialty Hospital in Tamil Nadu

Introduction: Corneal damage is the common issue affecting 70% of diabetic patients. Diabetic cornea has functional abnormalities such as decreased corneal Endothelial Cell Density (ECD), thicker corneas with increased endothelial permeability, lesser corneal sensitivity, and elevated corneal auto-fluorescence. Aim: To study the corneal endothelial characteristics among diabetic patients and to identify the factors associated with endothelial damage and compare the corneal changes based on the duration of diabetes mellitus and glycaemic control. Materials and Methods: The hospital based cross-sectional study was conducted in 155 patients (100 diabetic and 55 control) from 24th September 2016 to 29th March 2018. The corneal endothelial morphological features were evaluated using a non-contact EM-3000 specular microscope. The morphological characteristics of endothelial cell like the ECD, Coefficient of Variation (CV), Central Corneal Thickness (CCT), and percentage of hexagonal cells were compared between diabetic patients and the control population. Age, gender, blood pressure, duration of diabetes, fasting and Postprandial Blood Sugar (PPBS) HbA1c value, blood urea, and serum creatinine, Intra Ocular Pressure (IOP) were also recorded, and the endothelial cell characteristics were compared between the diabetic groups according to the duration (< or ≥ 3 years) and HbA1c% (< or ≥ 7%). An independent t-test was performed to compare the means of endothelial characteristics between study subjects and the control group and also between duration of diabetes and HbA1C levels. A p-value of less than 0.05 was considered statistically significant. The data were analysed using a SPSS statistical program. Results: Baseline characteristics like Fasting Blood Sugar (FBS), PPBS, HbA1c, Systolic and Diastolic Blood Pressure (SBP and DBP) were significantly higher in diabetic group than control. A significant difference in corneal thickness (p=0.01) and hexagonality (p<0.001) were also observed between both the groups. The diabetic group showed a reduction in cell density and a higher coefficient variation of cell size however the differences were not statistically significant, There was no significant difference in the ECD, CCT, CV, and hexagonality irrespective to HbA1c level and duration of diabetes. Conclusion: Patients with diabetes had a significant increase in corneal thickness, and a higher frequency of pleomorphism compared to control subjects. In terms of ECD and co-efficient variation, no difference was observed between groups.

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Corneal thickness and endothelial cell density in diabetic and non- diabetic patients: a hospital based comparative study

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20182125 ◽

2018 ◽

Vol 5 (3) ◽

pp. 694 ◽

Cited By ~ 1

Author(s):

Nagaraj G. ◽

Anasuya Sangaraj Desai ◽

Nagesh Jayaram

Keyword(s):

Endothelial Cell ◽

Cell Density ◽

Central Corneal Thickness ◽

Corneal Thickness ◽

Endothelial Cell Density ◽

Diabetic Group ◽

Control Group ◽

Diabetic Patients ◽

Specular Microscopy ◽

The Mean

Background: Diabetes mellitus is associated with structural changes in corneal endothelial cells and their thickness. The present study was done to compare the endothelial cell density (ECD), central corneal thickness (CCT) and morphology in diabetic and non-diabetic patients.Methods: A cross-sectional study was conducted at Minto Ophthalmic hospital, BMC and RI Bangalore for a period of 20 months (October 2013 - May 2015). A total of 200 study subjects, 100 diabetics and 100 non-diabetic age matched controls were selected, and complete timed ophthalmic evaluation was performed. Specular microscopy was performed on all patients for endothelial cell count assessment and corneal thickness was measured by Pachymeter. The data was analyzed and represented using descriptive statistics. ‘t’ test was used for comparing the two groups.Results: The mean endothelial cell density in diabetic group was significantly lower (2438.73±250.23cells/mm2) compared to non-diabetic group (2599.88±168.16cells/mm2) (p<0.0001). The mean Central corneal thickness in diabetic group was significantly higher (518.40±28.13 μm) compared to control group (490.14±24.31 μm) (p<0.001). The Co-efficient of variation percentage of the diabetics was higher than the non-diabetics but this difference was not statistically significant (P>0.05). The hexagonality percentage was significantly lower in diabetic group compared to the controls suggesting less pleomorphism in the diabetic group.Conclusions: The study concludes that the endothelial cell density was lower and central corneal thickness was higher in diabetic patients compared with the non-diabetics. The altered endothelial morphology was significantly seen in the form of pleomorphism (hexagonality) but polymegathism was not significantly altered.

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The effects of type 2 diabetes mellitus on the corneal endothelium and central corneal thickness

10.21203/rs.3.rs-109433/v1 ◽

2020 ◽

Author(s):

Tae Gi Kim ◽

Yoo Jin Kim

Keyword(s):

Type 2 Diabetes ◽

Endothelial Cell ◽

Central Corneal Thickness ◽

Corneal Thickness ◽

Corneal Endothelial Cell ◽

Control Group ◽

Diabetic Patients ◽

Duration Of Diabetes ◽

Significant Difference

Abstract Aim of this study is to evaluate the differences in corneal endothelial cell morphology and corneal thickness in patients with and without type 2 diabetes related to age, disease duration, and HbA1c percentage. This retrospective cross-sectional study included 511 type 2 diabetes patients (1022 eyes) and 900 (1799 eyes) non-diabetic patients. The endothelial cell density (ECD), variation in endothelial cell size (CV), percentage of hexagonal cells, and central corneal thickness (CCT) were analyzed using a noncontact specular microscope and a Pentacam Scheimpflug camera. We also examined the correlation between the corneal parameters and the duration of diabetes. Blood HbA1c results in DM patients were used within 2 months of ophthalmic examination. The controls had no diabetes confirmed by blood tests. For all ages, the subjects with type 2 diabetes showed significantly lower ECD, hexagonality, higher CV, and thicker CCT than the control group. This difference was more pronounced in patients with long-standing DM (≥10 years) and high HbA1c (≥7 %). When stratified by age group, from the 60s group, corneal endothelial cell parameters showed a statistically significant difference between DM and control groups. The duration of diabetes was inversely correlated with ECD (r=-0.167; P=0.000), but HbA1c was not correlated with ECD. These findings suggest that diabetes affects corneal endothelial cell in older age and those with long-standing DM and higher HbA1c. Regular corneal endothelial examinations are required in diabetic patients.

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The effects of type 2 diabetes mellitus on the corneal endothelium and central corneal thickness

Scientific Reports ◽

10.1038/s41598-021-87896-3 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Yoo Jin Kim ◽

Tae Gi Kim

Keyword(s):

Type 2 Diabetes ◽

Endothelial Cell ◽

Central Corneal Thickness ◽

Corneal Thickness ◽

Corneal Endothelial Cell ◽

Control Group ◽

Diabetic Patients ◽

Duration Of Diabetes ◽

Significant Difference

AbstractAim of this study is to evaluate the differences in corneal endothelial cell morphology and corneal thickness in patients with and without type 2 diabetes related to age, disease duration, and HbA1c percentage. This retrospective cross-sectional study included 511 (1022 eyes) type 2 diabetes patients and 900 (1799 eyes) non-diabetic patients. The endothelial cell density (ECD), variation in endothelial cell size (CV), percentage of hexagonal cells, and central corneal thickness (CCT) were analyzed using a noncontact specular microscope and a Pentacam Scheimpflug camera. We also examined the correlation between the corneal parameters and the duration of diabetes. For total ages, the subjects with type 2 diabetes showed significantly lower ECD, hexagonality, higher CV, and thicker CCT than the control group. This difference was more pronounced in patients with long-standing DM (≥ 10 years) and high HbA1c (≥ 7%). When stratified by age group, from the 60 s group, corneal endothelial cell parameters showed a statistically significant difference between DM and control groups. The duration of diabetes was inversely correlated with ECD (r = − 0.167; p = 0.000). These findings suggest that diabetes affects corneal endothelial cell in older age and those with long-standing DM and higher HbA1c. Regular corneal endothelial examinations are required in diabetic patients.

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Corneal Endothelial Morphology in Children with Type 1 Diabetes

Journal of Diabetes Research ◽

10.1155/2016/7319047 ◽

2016 ◽

Vol 2016 ◽

pp. 1-8 ◽

Cited By ~ 8

Author(s):

Mohamed Anbar ◽

Hatem Ammar ◽

Ramadan A. Mahmoud

Keyword(s):

Type 1 Diabetes ◽

Endothelial Cell ◽

Corneal Thickness ◽

Diabetic Group ◽

Control Group ◽

Normal Children ◽

Duration Of Diabetes ◽

Diabetic Children ◽

The Mean

Aim. To investigate corneal endothelial cell morphological in children with type 1 diabetes and to determine the systemic and local factors that contribute to these changes.Methods. One hundred sixty eyes of 80 children with type 1 diabetes and 80 eyes of 40 normal children as a control during the period from July 2015 to February 2016 underwent full clinical and ophthalmologic examination. We measured the central corneal thickness (CCT), endothelial cell density (ECD), ploymegathism, and pleomorphism using a noncontact specular microscope.Results. The mean age of the diabetic children was8.22±3.11years. The mean duration of type 1 diabetes was3.51±2.23years. The mean CCT was significantly higher:537±33.41microns (right eye), in the diabetic group compared to the control group. The mean ECD in patients with type 1 diabetes was3149.84±343.75cells/mm2(right eye), and it was significantly lower than in the control group. Furthermore, pleomorphism was significantly lower48.73±5.43% (right eye), in the diabetic group compared to the control group. The mean polymegathism was significantly higher37.96±5.61% (right eye), in the diabetic group compared to the control group. All of these changes are significantly correlated only with the duration of diabetes.Conclusions. Diabetic children have thicker corneas, lower ECD, an increased polymegathism, and a decreased pleomorphism. The duration of diabetes is the factor that affects all of these changes. To what extent these changes affect visional function on long term needs to be investigated in further studies.

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Risk of latent tuberculosis infection among diabetic patients in Azadi Teaching Hospital, Duhok province: a case control study

Asian Journal of Medical and Biological Research ◽

10.3329/ajmbr.v4i2.38259 ◽

2018 ◽

Vol 4 (2) ◽

pp. 227-232 ◽

Cited By ~ 1

Author(s):

Muayad A Merza ◽

Abdul Aziz Sulaiman Savo ◽

Muhammad Jaafer

Keyword(s):

Diabetes Mellitus ◽

Teaching Hospital ◽

Case Control Study ◽

Case Control ◽

Diabetic Group ◽

Control Group ◽

Diabetic Patients ◽

Duration Of Diabetes ◽

Previous Hospitalization ◽

Control Study

Diabetes can be linked with impaired host immunity that subsequently increases the rate of various infections including tuberculosis (TB), particularly in developing countries where TB is endemic. The objectives of this case control study were to determine the prevalence and the risk of LTBI among diabetic patients. It is a prospective case control study conducted in Azadi Teaching Hospital from September 2017 until May 2018. The diabetic patients included in this study were randomly selected. The diagnosis of diabetes mellitus (DM) was made according to the American Diabetes Association (ADA). Diabetes mellitus patients and the control participants were offered a voluntary tuberculin skin test (TST). The TST ≥10 mm was considered positive. The results were analyzed by entering the data in SPSS (statistical package for the social sciences, version 16; SPSS Inc., Chicago, Illinois, USA). Two hundred DM patients and 208 control individuals participated in this study. Collectively, 28 patients had positive TST results. Based on the sputum smear microscopy and CXR, none of these patients showed active TB disease. The differences between the DM patients and the control group had no statistical significance apart from previous hospitalization. The prevalence of LTBI was 23.53% in the diabetic group, whereas, it was 9.62% in the control group. The frequency of LTBI in diabetic patients was significantly higher than the control group. When the diabetic group was compared with the control group in terms of diabetic control and the duration of diabetes disease, there was a statistically significant association of diabetes duration ≥ 10 years and TST positivity. In conclusion, the previous hospitalization was a significant risk factor for diabetic patients to acquire TB bacilli. Latent TB infection was more common in diabetics than non diabetics and there was an increased likelihood of having LTBI with the duration of diabetes ≥ 10 years. To avoid the threatening of TB control program, prophylactic treatment of LTBI in diabetic patients is paramount.Asian J. Med. Biol. Res. June 2018, 4(2): 227-232

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Change in corneal endothelial cell density after phacoemulsification in patients with type II diabetes mellitus

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.35.5.596 ◽

2019 ◽

Vol 35 (5) ◽

Author(s):

Muhammad Khalid ◽

Muhammad Kashif Hanif ◽

Qamar Ul Islam ◽

Muhammad Asim Mehboob

Keyword(s):

Endothelial Cell ◽

Cell Density ◽

Type Ii Diabetes Mellitus ◽

Corneal Endothelial Cell ◽

Endothelial Cell Density ◽

Diabetic Patients ◽

Type Ii ◽

Significant Difference ◽

Corneal Endothelial Cell Density ◽

Study Population

Objective: To compare the mean change in Corneal Endothelial cell Density (CED), from baseline (pre-operative value), two months after phacoemulsification cataract surgery between type II diabetic patients and non-diabetic patients. Methods: This prospective stratified controlled study was conducted at PNS Shifa Hospital, Karachi. 80 eyes of 72 type II diabetic patients and 80 eyes of 77 non diabetic controls, having Nuclear Opalescence (NO) grades 2 and 3 on slit lamp examination underwent phacoemulsification surgery. CED was measured in cells/mm2, of concerned eye of each subject preoperatively and 2 months post operatively using specular microscope. The difference in mean CED change between the two groups after surgery was analyzed. Results: Mean age of study population was 61.41± 6.76 years. Out of study population, 92 (57.5%) were males and 68 (42.5%) were females. There was a statistically significant difference between both groups in terms of mean post-operative CED, mean change in CED and mean frequency change in CED (p <0.05). There was no statistically significant difference between both groups in age, gender, laterality of eyes and mean pre-operative CED, (p >0.05). Difference of pre-operative CED from post-operative CED in each group was statistically significant. Conclusion: There is a significant difference between diabetic population and normal population in terms of corneal endothelial loss after uneventful phacoemulsification cataract surgery. doi: https://doi.org/10.12669/pjms.35.5.596 How to cite this:Khalid M, Hanif MK, Qamar ul Islam, Mehboob MA. Change in corneal endothelial cell density after phacoemulsification in patients with type II diabetes mellitus. Pak J Med Sci. 2019;35(5):---------. doi: https://doi.org/10.12669/pjms.35.5.596 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Relationship between homocysteine and non-dipper pattern in patients with type 2 diabetes mellitus

Arquivos Brasileiros de Endocrinologia & Metabologia ◽

10.1590/s0004-27302012000500002 ◽

2012 ◽

Vol 56 (5) ◽

pp. 285-290 ◽

Cited By ~ 2

Author(s):

Serdal Korkmaz ◽

Abdulkerim Yilmaz ◽

Gürsel Yildiz ◽

Fatih Kiliçli ◽

Serhat Içağasioğlu

Keyword(s):

Diabetes Mellitus ◽

Blood Pressure ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Control Group ◽

Diabetic Patients ◽

Nocturnal Blood Pressure ◽

Type 2 Dm ◽

Significant Difference

OBJECTIVE: The rate of reduction of nocturnal blood pressure (NBP) is lesser than normal in patients with type 2 diabetes mellitus (type 2 DM). Hyperhomocysteinemia (HHC) disrupts vascular structure and function, no matter the underlying causes. The risk of development of vascular disease is greater in diabetic patients with hyperhomocysteinemia than in patients with normal homocystein levels. The aim of the study was to investigate whether there are differences of homocystein levels in dipper and non-dippers patients with type 2 DM. SUBJECTS AND METHODS: We compared 50 patients (33 females, 17 males) with type 2 DM and 35 healthy individuals (18 females, 17 males ) in a control group. Ambulatory blood pressure monitoring (ABPM) was performed and homocysteine levels were measured in all patients. RESULTS: We found that the percentage of non-dipper pattern was 72% in patients with type 2 DM and 57% in control group. In diabetic and control individuals, homocystein levels were higher in non-dipper (respectively 13.4 ± 8.1 µmol/L and 11.8 ± 5 µmol/L) than in dipper subjects (respectively, 11.8 ± 5.8 µmol/L and 10.1 ± 4.2 µmol/L), but there was no significant difference between the two groups (respectively, p = 0.545, p = 0.294). CONCLUSION: In both groups, homocystein levels were higher in non-dipper than in dipper participants, but there was no significant difference between the groups. High homocystein levels and the non-dipper pattern increases cardiovascular risk. Therefore, the relationship between nocturnal blood pressure changes and homocystein levels should be investigated in a larger study.

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Temperature Biofeedback Training to Improve Peripheral Blood Flow in the Upper Extremities of Diabetic Patients

Canadian Journal of Occupational Therapy ◽

10.1177/000841748405100501 ◽

1984 ◽

Vol 51 (5) ◽

pp. 219-224 ◽

Cited By ~ 1

Author(s):

Elizabeth Dean

Keyword(s):

Blood Pressure ◽

Blood Flow ◽

Diastolic Blood Pressure ◽

Peripheral Blood ◽

Diabetic Group ◽

Biofeedback Training ◽

Control Group ◽

Diabetic Patients ◽

Peripheral Blood Flow ◽

Temperature Biofeedback

Ten control and ten diabetic subjects were first given a baseline session of no temperature biofeedback, and then were exposed to four 40-minute temperature biofeedback sessions over consecutive days. As the result of feedback training, peripheral skin temperatures increased on the training (right) hands of both groups, and this occurred to a greater extent in the diabetic group. Concomitant temperature increases occurred also in the left hands of both groups. Neither group produced any significant changes in heart rate, respiration rate, or systolic blood pressure with the exception of a significant decrease in diastolic blood pressure for the diabetic group. No difference in diastolic blood pressure was observed, however, when the diabetics were compared with the control group. The results would suggest further evaluation of temperature biofeedback training is warranted in a diabetic population as a potential means of increasing peripheral blood flow in the extremities.

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A Controlled Study on the Correlation between Tear Film Volume and Tear Film Stability in Diabetic Patients

Journal of Ophthalmology ◽

10.1155/2016/5465272 ◽

2016 ◽

Vol 2016 ◽

pp. 1-5 ◽

Cited By ~ 2

Author(s):

Iman M. Eissa ◽

Noha M. Khalil ◽

Heba A. El-Gendy

Keyword(s):

Anterior Segment ◽

Tear Film ◽

Controlled Study ◽

Control Group ◽

Diabetic Patients ◽

Film Stability ◽

Duration Of Diabetes ◽

Significant Difference ◽

Tear Meniscus ◽

Tear Meniscus Height

Purpose. To assess the tear film quantity and correlate it with the quality and stability of the tear film in diabetics and compare them to age matched controls.Introduction. Diabetes affects tear film parameters in multiple ways. Poor metabolic control and neuropathy are postulated factors. To further understand how diabetes affects tear film parameters this study was conducted.Subjects and Methods. Tear meniscus height was measured by anterior segment OCT, along with tear thinning time, a subtype of noninvasive tear break-up time, and blinking rate per minute which were all recorded for 22 diabetic patients. Correlations between these tear film parameters were studied and then compared to 16 age matched controls.Results. A statistically significant difference was found in blinking rate between the diabetic and the control group (P=0.002), with higher blinking rate among diabetics. All tear film parameters were negatively correlated with duration of diabetes. A positive correlation was found between tear film volume and stability.Conclusion. Diabetes affects the tear film in various ways. Diabetics should be examined for dry eye signs even in absence of symptoms which may be masked by associated neuropathy. Duration of diabetes has an impact on tear film status.

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Influence of diabetes mellitus on corneal thickness

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh1410529s ◽

2014 ◽

Vol 142 (9-10) ◽

pp. 529-534 ◽

Cited By ~ 2

Author(s):

Ivan Sencanic ◽

Miroslav Stamenkovic ◽

Vesna Jovanovic ◽

Sinisa Babovic ◽

Vesna Jaksic ◽

...

Keyword(s):

Diabetes Mellitus ◽

Diabetic Retinopathy ◽

Healthy Subjects ◽

Corneal Thickness ◽

Ultrastructural Changes ◽

Control Group ◽

Diabetic Patients ◽

Ophthalmological Examination ◽

Study Results ◽

Significant Difference

Introduction. Ultrastructural changes in corneas of patients with diabetes mellitus have been previously described. Objective. The aim of this study was to compare central corneal thickness (CDR) values in diabetic patients without retinopathy at the stage of diabetic nonproliferative and proliferative retinopathy and CDR in a control group of healthy subjects. Methods. The study included 121 diabetic patients and 125 healthy subjects matched according to gender and age. Each patient underwent ophthalmological examination involving a dilated fundus examination and CDR measurement using the ultrasound pachymeter. The eyes of diabetic patients were classified according to Early Treatment Diabetic Retinopathy Study into three groups: without diabetic retinopathy (NDR), with nonproliferative diabetic retinopathy (NPDR) and a group with proliferative diabetic retinopathy (PDR). Only one eye of each subject was chosen for the study. Results. The mean CDR value was significantly higher in the diabetic group (570.52?31.81 ?m) compared with the control group (541.42?27.82 ?m). The difference between the two groups was statistically significant (p<0.0001). The highest mean CDR value was recorded in the PDR group (585.97?28.58 ?m), followed by the NPDR group (570.84?30.27 ?m), whereas the lowest mean CDR value was recorded in the NDR group (559.80?31.55 ?m). There was a statistically significant difference in CDR between the NDR and PDR groups, as well as between the NPDR and PDR groups (p<0.001, p<0.05 respectively). No significant difference was recorded between the NDR and NPDR groups (p>0.05). Conclusion. CDR of diabetic patients was higher compared to healthy subjects. The highest mean value of CDR was registered in the PDR group, followed by the NPDR and the NDR groups.

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