No Relation Between the Severity of Corneal Nerve, Epithelial, and Keratocyte Cell Morphology With Measures of Dry Eye Disease in Type 1 Diabetes

Abstract

PURPOSE. Patients with diabetes have a propensity to develop dry eye symptoms (DES), with reduced tear secretion and corneal sensitivity. The underlying pathologic basis of DES was explored in patients with Type 1 diabetes. METHODS. Forty-two patients with Type 1 diabetes mellitus (T1DM) (age: 49.21 6 2.53 years, duration of diabetes: 29.98 6 2.64 years) and 25 control subjects (age: 48.70 6 2.84 years) underwent assessment of DES using a validated dry eye questionnaire, and tear stability and tear production were assessed using tear breakup time (TBUT) and Schirmer's test, respectively. Corneal confocal microscopy was undertaken to quantify corneal nerve fiber density (CNFD), branch density (CNBD), fiber length (CNFL), keratocyte density (KD), and corneal epithelial basal cell (CEBC) density and area. RESULTS. The prevalence of DES was significantly higher (P ¼ 0.03), and TBUT (P ¼ 0.006), corneal sensation (P < 0.0001), CNFD (P ¼ 0.001), CNBD (P ¼ 0.001), CNFL (P ¼ 0.003), and KD (P ¼ 0.04) were significantly lower in patients with T1DM compared to control subjects. However, these measures did not differ significantly between T1DM patients with and without dry eye. There was no correlation between DES and TBUT or corneal nerve keratocyte and CEBC morphology. CONCLUSIONS. DES and TBUT are significantly increased in patients with T1DM, but are not related to corneal nerve, basal epithelial, or keratocyte cell morphology.

Topical citicoline and vitamin B12 versus placebo in the treatment of diabetes-related corneal nerve damage: a randomized double-blind controlled trial

“…These results are in agreement with a large part of literature, bringing evidence that nerve trophism plays a key role on the ocular surface homeostasis, and loss of neural network integrity or correct function is a frequent cause of dry eye disease [26], because of reduced corneal sensitivity and lacrimal gland dysfunction with reduced tear production and tear stability [27]. Our population was not selected on the basis of OS findings, and we found out that at baseline patients with abnormal OSDI had significantly lower sensitivity (21 ± 12 mm) than those with normal OSDI (39 ± 18 mm).…”

“…These results are in contrast with Lyu et al [28], who suggested that patients with longstanding diabetes may be less symptomatic due to corneal denervation. Another recent paper by Ferdousi et al [27] found out that DED prevalence in 42 patients with type-1 diabetes was not related with corneal nerve structure and density. Probably, these controversial findings reflect the well-known different effects due to type of diabetes [29], populations (DED on patients with diabetes ranges from 17.5% [30] up to 76.5% [31]), and stage of the disease [32].…”

Topical citicoline and vitamin B12 versus placebo in the treatment of diabetes-related corneal nerve damage: a randomized double-blind controlled trial.

“…These results are in agreement with a large part of literature, bringing evidence that nerve trophism plays a key role on the ocular surface homeostasis, and loss of neural network integrity or correct function is a frequent cause of dry eye disease (26), because of reduced corneal sensitivity and lacrimal gland dysfunction with reduced tear production and tear stability (27). Our population was not selected on the basis of OS ndings, and we found out that at baseline patients with abnormal OSDI had signi cantly lower sensitivity (21 ± 12 mm) than those with normal OSDI (39 ± 18 mm).…”

“…These results are in contrast with Lyu et al (28), who suggested that patients with longstanding diabetes may be less symptomatic due to corneal denervation. Another recent paper by Ferdousi et al (27) found out that DED prevalence in 42 patients with type-1 diabetes was not related with corneal nerve structure and density. Probably, these controversial ndings re ect the well-known different effects due to type of diabetes (29), populations (DED on patients with diabetes ranges from 17.5% (30) up to 76.5% (31)), and stage of the disease (32).…”

Topical citicoline and vitamin B12 versus placebo in the treatment of diabetes-related corneal nerve damage: a randomized double-blind controlled trial.

“…These results are in contrast with Lyu et al (22), who suggested that patients with longstanding diabetes may be less symptomatic due to corneal denervation. Another recent paper by Ferdousi et al (21) found out that DED prevalence in 42 patients with type-1 diabetes was not related with corneal nerve structure and density. Probably, these controversial findings reflect the well-known different effects due to type of diabetes (23), populations (DED on patients with diabetes ranges from to 17.5% (24) up to 76.5% (25)), and stage of the disease (19).…”