Ocular surface microbiome in diabetes mellitus

Abstract

This cross-sectional, age- and gender-matched study included 20 eyes of non-diabetic subjects (non-DM group) and 60 eyes of type 2 diabetes mellitus (DM group). Subgroups of DM were classified by diabetic retinopathy (DR) staging into no DR (DM-no DR), non-proliferative DR (DM-NPDR), proliferative DR (DM-PDR), and by glycemic control (well-controlled DM; HbA1c < 7%, poorly controlled DM; HbA1c ≥ 7%). Conjunctival swabs were performed for ocular surface microbiome analysis using conventional culture and next-generation sequencing analysis (NGS). A higher culture-positive rate was found in DM (15%) than in non-DM group (5%) (p value = 0.437). Pathogenic organisms and antibiotic-resistant strains were detected in the DR groups (DM-NPDR and DM-PDR). The NGS analysis showed that potentially pathogenic bacteria such as Enterobacteriaceae, Neisseriaceae, Escherichia-Shigella, and Pseudomonas predominated in DM, especially in DR. There was dissimilarity in the ocular surface microbiome between DM and non-DM groups. The subgroup analysis showed that the DR group had significantly different microbial community from DM-no DR and non-DM groups (p value < 0.05). The microbial community in the poorly controlled DM was also significantly different from well-controlled DM and non-DM groups (p < 0.001). Using the NGS method, our study is the first to signify the importance of DR and glycemic control status, which affect the changes in the ocular surface microbiome.

Effects of dietary imbalances of micro- and macronutrients on the ocular microbiome and its implications in dry eye disease

“…It was postulated that vitamin D deficiency could promote ADDE instead of evaporative dry eye, as Schirmer's test between the groups was significantly different whilst the TBUT scores were comparable. Further, patients with dry eye syndrome refractive to standard administered high doses of intramuscular cholecalciferol had improvements in all outcome measures, albeit only short-term [146].…”

Immune Fingerprint in Diabetes: Ocular Surface and Retinal Inflammation

“…A recent study of conjunctival swabs using conventional culture and next-generation sequencing (NGS) analysis has reported that potentially pathogenic bacteria such as Enterobacteriaceae, Neisseriaceae, Escherichia – Shigella , and Pseudomonas were more prevalent in diabetes, particularly in DR. Dissimilarities in the ocular surface microbiome were also observed between diabetic and non-diabetic groups. Interestingly, the ocular surface microbiome in poorly controlled diabetic patients differs significantly from well-controlled diabetic and non-diabetic groups [ 3 ]. In poorly controlled diabetic patients, an inappropriate immune response can cause ocular surface microbiome dysbiosis and increase the abundance of potentially harmful bacteria, especially in DR [ 123 , 124 , 125 , 126 ].…”

“…With a thorough knowledge of diabetes, it is believed that oxidative stress, autoimmunity, genetics, and epigenetics play major roles in the onset of diabetes and its complications [ 2 ]. Although the most frequent and well-known ocular complication of diabetes is diabetic retinopathy (DR), with approximately one-third of all people with diabetes experiencing related vision complications, recent reports have focused on how diabetes affects the ocular surface [ 3 , 4 ], a structure similarly impacted by diabetes [ 5 ].…”

The gut-retina axis: a new perspective in the prevention and treatment of diabetic retinopathy

“…However, Suwajanakorn et al. ( 68 ) used next-generation sequencing analysis to demonstrate the importance of DR and glycemic control status in influencing changes in the ocular surface microbiome. Subsequent studies identified that microbes could be transferred to the retina of type 1 diabetic mice with retinopathy through gut and plasma microbiota ( 69 ).…”