An Update on Corneal Biomechanics and Architecture in Diabetes

Buey, M.Á. Del; Casas, P; Caramello, C; López, Núria; Rica, Marisa de la; Subirón, Ana B.; Lanchares, Elena; Huerva, Valentín; Grzybowski, Andrzej; Ascaso, Francisco J.

doi:10.1155/2019/7645352

Cited by 26 publications

(39 citation statements)

References 153 publications

(191 reference statements)

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“…If endothelial cell loss occurs, the frequency of tight junctions between cells decreases, allowing more aqueous humour to enter the corneal stroma. Consequently, CCT increases with the loss of corneal transparency [29]. Regarding CCT in the present study, there was no significant difference between subjects in the DME, no-DME, and control subgroups.…”

Section: Discussioncontrasting

confidence: 53%

Corneal endothelial alterations in patients with diabetic macular edema

Gündüz¹,

Ulutaş²,

Yener³

et al. 2021

Journal of Surgery and Medicine

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Background/Aim: Diabetic macular edema (DME) is the main cause of visual loss in diabetic patients. Although it is known that diabetes mellitus could affect all corneal layers, there is no data about the morphological and quantitative changes of corneal endothelium in patients with DME. The aim of this study is to evaluate the corneal endothelial cell density (CD), morphology and central corneal thickness (CCT) in patients with DME. Methods: This retrospective study included 47 diabetic patients (79 eyes) with DME, 48 diabetic patients (93 eyes) without DME, and 46 nondiabetic subjects (74 eyes). Diagnosis of DME was based on fundoscopy and optical coherence tomography imaging. The corneal endothelial structure and CCT were evaluated using non-contact specular microscopy. The endothelial CD (cells/mm 2 ), coefficient variation of cell area (CV), percentage of hexagonality (HEX) and CCT of the three subgroups were compared. Results: The mean age of participants was 59.8 (8.3) years. There was no significant difference in terms of age between diabetic patients and control subjects (P=0.761). In the diabetic subgroups, HbA1c levels and the number of patients receiving insulin were similar (P=0.962, P=0.082, respectively), but the mean duration of diabetes was significantly longer in the DME subgroup than in the no-DME subgroup (P=0.015). Patients in the DME subgroup did not differ from the patients in the no-DME and control subgroups with regards to endothelial CD and CCT. However, there was a statistically significant decrease in HEX and increase in CV in patients with DME (P=0.012, P=0.012, respectively). Conclusion:Patients with DME were found to have higher rates of polymegathism and polymorphism although there were no significant changes in corneal endothelial CD and CCT. These alterations may be the first signs of early corneal damage in patients with DME.

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Section: Discussioncontrasting

confidence: 53%

Corneal endothelial alterations in patients with diabetic macular edema

Gündüz¹,

Ulutaş²,

Yener³

et al. 2021

Journal of Surgery and Medicine

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“…Earlier studies showed significant alterations in corneal biomechanical properties in DM. 2 However, according to the current results, these changes might not be strong enough to have a significant impact on IOP measurement in DM.…”

Section: Discussionmentioning

confidence: 56%

“…22 This higher CCT influence on CRF might be the reason for its significant correlation to GAT-IOP in contrast to CH. On the other hand, higher viscoelastic properties of the cornea (assumable induced by changes of the corneal ground substance in DM) 2 cause a higher resistance against deformation and the time and pressure of the first applanation (P1) increase. During the return, second applanation is reached later (lower P2) and CH increases.…”

Section: Discussionmentioning

confidence: 99%

“…There is increasing evidence that DM also influences corneal architecture and biomechanics. 2 These changes include an increase in glycosylation of proteoglycans and glycosaminoglycans and an accumulation of advanced glycosylation end products (AGEs). Furthermore, a higher crosslinking of collagen fibrils and proteoglycans in the corneal stroma is assumed.…”

Section: Introductionmentioning

confidence: 99%

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Intraocular pressure measurements in diabetes mellitus

Ramm

Herber

Spoerl

et al. 2019

European Journal of Ophthalmology

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Purpose: To investigate the impact of diabetes mellitus–induced changes on intraocular pressure measurements using Goldmann applanation tonometry, Ocular Response Analyzer, and Corvis ST. Methods: Measurements were done using Goldmann applanation tonometry, Ocular Response Analyzer, and Corvis ST in 69 diabetic patients. Biomechanical-corrected intraocular pressure values by Ocular Response Analyzer (IOPcc) and Corvis ST (bIOP) were used. In addition, biometry and tomography were performed and information on diabetes mellitus specific factors was collected. Results were compared to an age-matched group of 68 healthy subjects. Results: In diabetes mellitus, Goldmann applanation tonometry intraocular pressure (P = 0.193) and central corneal thickness (P = 0.184) were slightly increased. Also, IOPcc (P = 0.075) and bIOP (P = 0.542) showed no significant group difference. In both groups, IOPcc was higher than Goldmann applanation tonometry intraocular pressure (P = 0.002, P < 0.001), while bIOP was nearly equal to Goldmann applanation tonometry intraocular pressure (P = 0.795, P = 0.323). Central corneal thickness showed a tendency to higher values in poorly controlled than in controlled diabetes mellitus (P = 0.059). Goldmann applanation tonometry intraocular pressure correlated to central corneal thickness, while IOPcc and bIOP were independent from central corneal thickness in both groups. All intraocular pressure values showed significant associations to corneal biomechanical parameters. Only in diabetes mellitus, bIOP was correlated to Pachy slope (P = 0.023). Conclusion: In diabetes mellitus, Goldmann applanation tonometry intraocular pressure was slightly, but not significantly, increased, which might be caused by a higher central corneal thickness and changes in corneal biomechanical properties. However, intraocular pressure values measured by Ocular Response Analyzer and Corvis ST were not significantly different between diabetes mellitus patients and healthy subjects. The bIOP showed a higher agreement with Goldmann applanation tonometry than IOPcc and was independent from central corneal thickness.

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“…Sorbitol acts as an osmotic agent and causes stromal hydration 16 . By increasing the corneal permeability these mechanisms lead to the morphological changes, such as decreased endothelial cell density, decreased percentage of hexagonal cell below 50%, and increased coefficient of variation of cell area 17,18 . That is subsequently followed by increased CCT.…”

Section: Discussionmentioning

confidence: 99%

The influence of diabetes mellitus type 2 on the central corneal thickness

et al. 2022

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Background/Aim: Complications of diabetes mellitus (DM) in the eye are the leading cause of blindness in the world. Although research on DM is mainly focused on retinal damage, changes in the cornea are also associated with DM. Central corneal thickness (CCT) reflects the metabolic status of the cornea and is also affected by DM. Knowledge of CCT changes that occur within DM is important for accurate IOP measurement, diagnosis and monitoring of patients with glaucoma. The main goal of the study was to examine the effect of DM type 2 on central corneal thickness. Methods: The study was designed as a clinical, cross sectional, observational study. It consists of 96 patients, divided into two groups. The first group consisted of 49 patients diagnosed with DM type 2. The second group was the control group and consisted of 47 healthy subjects. The DM group is divided into subgroups depending on the status of diabetic retinopathy, the length of DM treatment, and the levels of glycosylated hemoglobin (HbA1C). Results: A statistically significant difference in CCT was observed among DM patients and the control group. Analyzing only DM patients, the highest CCT values were observed in patients who had HbA 1C > 7.0%, as well as those who treated DM for more than 15 years, with a statistically significant difference in relation to the corresponding patient subgroups (p=0.002 and p=0.037). No statistical significance was observed depending on the status of retinopathy. Intraocular pressure (IOP) was also statistically significantly higher in patients with DM compared to the control group. Conclusion: Previous research has mainly focused on the complications of diabetes in the posterior segment of the eye. Knowing that the increase in CCT also affects the measured IOP values, this research will be useful in better understanding and control of the patients who have glaucoma in addition to DM type 2.

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An Update on Corneal Biomechanics and Architecture in Diabetes

Cited by 26 publications

References 153 publications

Corneal endothelial alterations in patients with diabetic macular edema

Corneal endothelial alterations in patients with diabetic macular edema

Intraocular pressure measurements in diabetes mellitus

The influence of diabetes mellitus type 2 on the central corneal thickness

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