Evaluation of changes in corneal endothelium in chronic kidney disease

Abstract

Purpose: Chronic kidney disease (CKD) is an emerging health problem worldwide. In CKD corneal endothelial changes also occur probably due to accumulation of inflammatory cytokines and increased multiple toxic products. The aim of this study was to analyze the effect of CKD on corneal endothelium and correlate the findings with severity of disease with help of noninvasive technique. Methods: The study comprised 75 eyes of 75 cases divided into three groups with group A comprising of CKD cases on dialysis, group B of nondialysis CKD cases, and group C of controls. Each group had 25 cases each of either sex and between 15–80 age groups. All patients were investigated for blood urea, serum creatinine, and blood sugar and underwent complete ophthalmic examination of both eyes along with wide-field specular microscopy examination. Results: The majority of patients (33.3%) belonged to age range of 61–70 years with male predominance and the most common cause of CKD was found to be diabetes with 17 (34%) cases. We found normal corneal endothelial cell density (ECD) with the mean ECD of 2364.52 ± 397.72 mm 2 in the dialysis group, 2467.8 ± 352.88 mm 2 in nondialysis group, and 2521.68 ± 250.26 mm 2 in the control group of patients. However, we found significant increase in coefficient of variation (CV) with 36 ± 5.8% in dialysis group, 37 ± 4.5% in nondialysis group and 32 ± 0.8% in controls ( P = 0.001) and decreased hexagonality (Hx) with 47 ± 7.3% in dialysis group, 46 ± 4.7% in nondialysis group and 51 ± 6.7% in the controls ( P = 0.031). This showed increased tendency of pleomorphism and polymegathism in corneal endothelial cells in CKD cases. No correlation was found between blood urea or serum creatinine levels with endothelial parameters in any group. Conclusion: CKD causes morphological changes like polymegathism and pleomorphism in corneal endothelium and hence these cases are more vulnerable and special care should be taken before any intraocular surgical procedure.

Effect of mitomycin C on the corneal endothelial cells of Saudi patients with myopia after transepithelial photorefractive keratectomy: a two-armed cohort study

“…The CV is a sign of pleomorphism, whereas the percentage of hexagonality is a measure of polymegathism [29] . Changes in the hexagonality of the ECs indicate cell damage.…”

Ocular manifestations in renal diseases

“…[ 59 ] CKD also causes morphological changes in corneal endothelium such as pleomorphism and polymegathism, making them more vulnerable to endothelial decompensation. [ 60 ] Patients undergoing hemodialysis develop chronic irritation due to decreased tear production[ 61 ] and alterations in the blink reflex. [ 62 ] Treatment consists of tear film supplementation with artificial tears.…”