Corneal endothelial alterations in patients with diabetic macular edema

Year 2021, Volume: 5 Issue: 2, 120 - 123, 01.02.2021

Gamze Uçan Gündüz , Hafize Gökben Ulutaş , Neslihan Yener , Özgür Yalçınbayır

https://doi.org/10.28982/josam.862849

Cited By: 2

Abstract

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/mm2), 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.

Keywords

corneal endothelium, diabetic macular edema, polymegathism, polymorphism, specular microscopy

References

• 1. Romero-Aroca P, Baget-Bernaldiz M, Pareja-Rios A, Lopez-Galvez M, Navarro-Gil R, Verges R. Diabetic macular edema pathophysiology: vasogenic versus inflammatory. J Diabetes Res. 2016;2016:2156273. doi: 10.1155/2016/2156273.
• 2. Das A, McGuire PG, Rangasamy S. Diabetic macular edema: pathophysiology and novel therapeutic targets. Ophthalmol. 2015;122:1375-94.
• 3. Gan L, Fagerholm P, Palmblad J. Vascular endothelial growth factor (VEGF) and its receptor VEGFR-2 in the regulation of corneal neovascularization and wound healing. Acta Ophthalmol Scand. 2004;82:557–63.
• 4. Ljubimov AV. Diabetic complications in the cornea. Vision Res. 2017;139:138-52.
• 5. Schmidt-Erfurth U, Garcia-Arumi J, Bandello F, Berg K, Chakravarthy U, Gerendas BS, et al. Guidelines for the management of diabetic macular edema by the European Society of Retina Specialists (EURETINA). Ophthalmologica. 2017;237:185-222.
• 6. Falavarjani KG, QD Nguyen. Adverse events and complications associated with intravitreal injection of anti-VEGF agents:a review of literature. Eye. 2013;27:787–94.
• 7. Galgauskas S, Laurinavičiūtė G, Norvydaitė D, Stech S, Ašoklis R. Changes in choroidal thickness and corneal parameters in diabetic eyes. Eur J Ophthalmol. 2016;26:163-7.
• 8. Calvo-Maroto AM, Cerviño A, Perez-Cambrodí RJ, García-Lázaro S, Sanchis-Gimeno JA. Quantitative corneal anatomy: evaluation of the effect of diabetes duration on the endothelial cell density and corneal thickness. Ophthalmic Physiol Opt. 2015;35:293-8.
• 9. El-Agamy A, Alsubaie S. Corneal endothelium and central corneal thickness changes in type 2 diabetes mellitus. Clin Ophthalmol. 2017;11:481-6.
• 10. Storr-Paulsen A, Singh A, Jeppesen H, Norregaard JC, Thulesen J. Corneal endothelial morphology and central thickness in patients with type II diabetes mellitus. Acta Ophthalmol. 2014;92:158-60.
• 11. Shenoy R, Khandekar R, Bialasiewicz A, Al Muniri A. Corneal endothelium in patients with diabetes mellitus: a historical cohort study. Eur J Ophthalmol. 2009;19:369-75.
• 12. Durukan I. Corneal endothelial changes in type 2 diabetes mellitus relative to diabetic retinopathy. Clin Exp Optom. 2020;103:474-8.
• 13. Itoh Y, Petkovsek D, Kaiser PK, Singh RP, Ehlers JP. Optical coherence tomography features in diabetic macular edema and the impact on anti-VEGF response. Ophthalmic Surg Lasers Imaging Retina. 2016;47:908-13.
• 14. Quadrado MJ, Popper M, Morgado AM. Diabetes and corneal cell densities in humans by in vivo confocal microscopy. Cornea. 2006;35:761-8.
• 15. Choo M, Prakash K, Samsudin A, Soong T, Ramli N, Kadir A. Corneal changes in type II diabetes mellitus in Malaysia. Int J Ophthalmol. 2010;3:234-6.
• 16. Matsuda M, Ohguro N, Ishimoto I, Fukuda M. Relationship of corneal endothelial morphology to diabetic retinopathy, duration of diabetes and glycemic control. Jpn J Ophthalmol. 1990;34:53-6.
• 17. Taşlı NG, Icel E, Karakurt Y, Ucak T, Ugurlu A, Yilmaz H, et al. The findings of corneal specular microscopy in patients with type-2 diabetes mellitus. BMC Ophthalmol. 2020;20:214.
• 18. Goldstein AS, Janson BJ, Skeie JM, Ling JJ, Greiner MA. The effects of diabetes mellitus on the corneal endothelium: A review. Surv Ophthalmol. 2020;65:438-50.
• 19. Leelawongtawun W, Suphachearaphan W, Kampitak K, Leelawongtawun R. A comparative study of corneal endothelial structure between diabetes and non-diabetes. J Med Assoc Thai. 2015;98:484-8.
• 20. Qu JH, Li L, Tian L, Zhang XY, Thomas R, Sun XG. Epithelial changes with corneal punctate epitheliopathy in type 2 diabetes mellitus and their correlation with time to healing. BMC Ophthalmol. 2018;18:1.
• 21. Urban B, Raczyńska D, Bakunowicz-Łazarczyk A, Raczyńska K, Krętowska M. Evaluation of corneal endothelium in children and adolescents with type 1 diabetes mellitus. Mediators Inflamm. 2013;2013:913754. doi: 10.1155/2013/913754.
• 22. Anbar M, Ammar H, Mahmoud RA. Corneal endothelial morphology in children with type 1 diabetes. J Diabetes Res. 2016;2016:7319047. doi: 10.1155/2016/7319047.
• 23. Szalai E, Deák E, Módis L Jr, Németh G, Berta A, Nagy A, et al. Early corneal cellular and nerve fiber pathology in young patients with type 1 diabetes mellitus identified using corneal confocal microscopy. Invest Ophthalmol Vis Sci. 2016;57:853-8.
• 24. Módis L Jr, Szalai E, Kertész K, Kemény-Beke A, Kettesy B, Berta A. Evaluation of the corneal endothelium in patients with diabetes mellitus type I and II. Histol Histopathol. 2010;25:1531-7.
• 25. Islam QU, Mehboob MA, Amin ZA. Comparison of corneal morphological characteristics between diabetic and non diabetic population. Pak J Med Sci. 2017;33:1307-11.
• 26. Benetz BA, Yee R, Bidros M, Lass J. Specular microscopy. In: Krachmer JH, Mannis MJ, Holland EJ, eds. Cornea: Fundamentals, Diagnosis and Management. 3rd ed. China, Mosby Elsevier; 2011. pp.177-203.
• 27. Leelawongtawun W, Surakiatchanukul B, Kampitak K, Leelawongtawun R. Study of corneal endothelial cells related to duration in diabetes. J Med Assoc Thai. 2016;99:182-8.
• 28. Yee RW, Matsuda M, Schultz RO, Edelhauser HF. Changes in the normal corneal endothelial cellular pattern as a function of age. Curr Eye Res. 1985;4:671-8.
• 29. Del Buey MA, Casas P, Caramello C, López N, de la Rica M, Subirón AB, et al. An update on corneal biomechanics and architecture in diabetes. J Ophthalmol. 2019;2019:7645352. doi: 10.1155/2019/7645352.
• 30. Sahu PK, Das GK, Agrawal S, Kumar S. Comparative evaluation of corneal endothelium in diabetic patients undergoing phacoemulsification. Middle East Afr J Ophthalmol. 2017;24:195-201.