Abstract
Objective:To compare corneal morphological parameters between diabetics and age matched non-diabetic control subjects and to evaluate the correlation of these parameters in relation to duration of diabetes mellitus (DM), glycemic status and severity of diabetic retinopathy.(DR).Methods:This cross sectional comparative study was conducted at the Department of Ophthalmology, PNS Shifa Karachi from February 2016 to January 2017. Patients with ages between 10 to 80 years of either gender who were diagnosed to have DM were recruited in the study. Control group comprised of age matched healthy volunteers who did not have DM. Corneal morphological parameters (CED, Average cell size, CV of cell size and hexagonality) was evaluated in each subject with non-contact specular microscope and findings were endorsed on a pre devised proforma.Results:Data of 298 eyes (149 diabetic patients and 149 healthy controls) was evaluated. Mean corneal endothelial cell density (CED) of diabetic population was 2494.47 ± 394.10 cells/mm2, while mean CED of control group was 2574.46 ± 279.97 cells/mm2 [p = 0.04]. Between group differences in mean average cell size, CV of cell size and hexagonality was statistically not significant. Analysis of corneal endothelial parameters among subgroups of patients with no DR, with NPDR and PDR did not show statistically significant difference. Moreover, patients with diabetes of more than 10 years duration had significantly lower CED (p <0.01) and larger average cell size (p= 0.03). Duration of DM was significantly correlated with type of DR, HbA1c level, CED, polymegethism and hexagonality.Conclusion:Mean corneal endothelial cell density (CED) was found to be significantly lower in diabetic population as compared to healthy controls.
Highlights
Diabetes Mellitus (DM) has become a global epidemic with Pakistan being no exception having 7.0 million patients of DM and the number of diabetic patients is expected to rise to an alarming figure of 14.4 million by the year 2040 making Pakistan the 8th highest country in terms of burden of DM.[1]
Apart from diabetic retinopathy (DR), several structural and functional changes in cornea have been associated with DM that include decrease in corneal endothelial cell density (CED)
Results of this study provide a greater insight into the understanding of corneal morphology in diabetic population especially in the context of pre-operative evaluation
Summary
Diabetes Mellitus (DM) has become a global epidemic with Pakistan being no exception having 7.0 million patients of DM and the number of diabetic patients is expected to rise to an alarming figure of 14.4 million by the year 2040 making Pakistan the 8th highest country in terms of burden of DM.[1]. Lower CED and hexagonality with higher coefficient of variation (CV) and average cell size had been reported by various authors.[3,4,5] there are studies that showed no difference in corneal morphology between diabetics and normal population.[6,7,8] Correlation of these morphological parameters with duration of DM, type and severity of DR and glycemic control had been studied with variable results. Rizvi et al in their study reported mean CED in Type-2 diabetics being significantly lower than the healthy adults.[9] In depth analysis of corneal morphological parameters (CED, average cell size, hexagonality and CV) among diabetics and healthy adult population from our country is not available. The objective of this study was to compare corneal morphological parameters (CED, CV, hexagonality and average cell size) between diabetics and age matched non diabetic control subjects and to evaluate the correlation of these parameters in relation to duration of DM, glycemic status and severity of DR
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