Corneal Endothelial Degeneration and Fibrous Proliferation After Pars Plana Vitrectomy

Tear film and ocular surface changes in diabetes mellitus

“…(32) Metformin Reduce hepatic Higher overall risk reduction glucose production with lower side effects (32) Peroxisome proliferatorEnhance insulin action Inhibition of IL-1 β, endothelial activated receptor-γ agonists cells apoptosis and micro (thiazolidinediones) vascular proliferation (82)(83) α-Glucosidase inhibitors Decrease the absorption Potential role on ocular tissue and ingestion of carbohydrates development and metabolism (84)(85) from the intestine Insulin Suppresses glucose production Reduction of risk of diabetic ocular and augments glucose utilization complications (13) .Tissue differentiation, growth, metabolism and extrapancreatic production (54,72) Corneal and conjunctival epithelial alterations, persistent epithelial defects, which are frequently associated with evident fragility during intraocular surgeries, and potential visual impairment due to corneal scaring have been observed (5,19,(33)(34)(35)(36)(37) . Those pathological alterations are not limited to anterior layers of the cornea (38)(39) . A potential explanation combines chronic tear secretion deficiency, peripheral neuropathy and hyperglycemia leading to corneal epitheliopathy with complications as hyperosmolarity punctate keratopathy, recurrent erosions, persistent epithelial defects, neurotrophic keratopahty, wound healing delay, and higher risk of microbial keratitis (40)(41)(42) (Figure 4).…”