Le segment antérieur de l’œil des diabétiques

Abstract

To study the damage to the anterior segment of the eye during mellitus diabetes. We prospectively studied the anterior segment of the eye in 200 diabetic patients and 200 patients with no history of diabetes (control group). Parameters included the corneal curvature radius, corneal thickness, central corneal sensitivity (Cochet Bonnet esthesiometer), pupil diameter before and after dilation using tropicamide and phenylephrine eye drops, delay for maximal pupil dilation, lens transparency, and intraocular pressure. The damage to the anterior segment was compared in both groups and was correlated with the parameters of diabetes (type, duration, and equilibration), retinopathy grade, and peripheral neuropathy. Corneal geometry (i.e., curvature radius and thickness) and intraocular pressure did not correlate with diabetes. Cataract was significantly influenced by diabetes (p<0.001). The duration needed to obtain pharmacological maximal mydriasis significantly correlated with iris color (rs=0.47, p<0.001), patient age (rs=0.28, p<0.001) and diabetes (rs=0.25, p<0.001). Dilation was significantly longer in the diabetic patient than in those of the control group (36.5 min vs 30.7 min, p<0.001). Corneal sensitivity significantly correlated with age (rs=0.48, p<0.001) and diabetes (rs=0.53, p<0.001). Corneal sensitivity was decreased in the diabetic group (5.42 vs 5.94, p<0.001) and it correlated with retinopathy grade (rs=0.47, p<0.001) and with peripheral neuropathy (rs=0.15, p<0.001). Sensitivity and specificity of hypoesthesia in detecting peripheral neuropathy were 67.4% and 49.4%, respectively. Among the parameters of diabetes, duration of progression showed the strongest correlation with damage to anterior segment (rs > or = 0.25, p<0.001). Diabetes influences lens transparency, pharmacological pupil dilatation and corneal sensitivity. In spite of the unspecific character of the damage and the subjectivity of the measurement, corneal sensitivity is an interesting parameter to take into consideration among diabetic patients.