Observe The Bulbar Conjunctiva And Bulbar Conjunctiva Microcirculation Changes Of Type2Diabetic Patients By Laser Scanning Confocal Microscopy

Purpose：Applying the Laser Scanning Confocal Microscope to observe changesof the bulbar conjunctiva and Conjunctival microvascular of patients with2diabetes，to explore the relationship between conjunctival microvascular changes and thediabetic retinopathy，which will provide new ways to diagnose and predict the2diabetes diabetic retinopathy.Methods：30patients（55eyes） with2diabetes who didn’t had systemicdiseases、eye injury infection and contact lens cornea.19patients (35eyes)with2diabetes,8male and11female,the mean age is58±8.69year(46～70year).course ofdeisease:1-20year,the average course is5years.11healthy volunteers(20eyes):9male,2female,the mean age is58±8.61year(42～71year). Patiens were detected bythe Slit Lamp Microscope.If one of couple eyes accords with the statistical standards,which will be as onesample,a part of patients has single eye detected,so the total number will change.The group of2diabetes was devided into3gropus.1.blood sugar controlledwell:3patients with5eyes(glycated hemoglobin:<6.2％).2. blood sugar controlled common:6patients with11eyes(6.2～8.0％).3. blood sugar controlled bad:10patients with19eyes（>8.0％）.Groups were devided by course of desease.1.<5year:10patients with19eyes;2.5-10year:3patients with6eyes.3.>10years:46patients with10eyes.6patients with8eyes who didn’t have diabetic retinopathy.diabetic retinopathy has3stages:patients in NPDR had9patients with10eyes;patients in PPDR had8patients with9eyes; patients in PDR had7patients with8eyes.To observe the bulbar conjunctiva and the form of Conjunctival microvascularby the Slit Lamp Microscope. The Laser Scanning Confocal Microscope wasdetected to observe the form of epithelial epilimmion cell、Stratum intermediumcell、basal cell and the Goblet celland to count the numbers of the above-mentionedcells.the bulbar conjunctiva microflow was devided into6stages: Linear flow line,grain, grain flow, grain, grain flow and halt. grain flow, grain, grain flow and haltwere marked as abnormal stage.To observe the form of Conjunctival microvascularAnalysing the differences of the density of cells between patients with2deabetesand healthy volunteers;analysing the differences of the changes of the conjunctivamicroflow between patients with2deabetes and healthy volunteers; analysing therelationship between the changes of cell density and the changes of conjunctivamicroflow and microvascular; Analysing the relationship betwwen the condition ofblood sugar control and the changes of conjunctiva microflow; Analysing therelationship of the Conjunctival microflow, microvascular changes and diabeticretinopathy.Result： The conjunctiva microvasculars were detected by the Slit LampMicroscope,we observed more hemangioma cystic expansion and the vessle size isdiffer.conjunctival epithelium cells can be devided into superficial layer of cells,interface layer cells and basal cells.Conjunctival superficial layer of cells：the average of density of patients with2 diabetes is1522±193／mm~2, the average of density of control group is1897±160／mm~2,P=0.000<0.05,the number of Conjunctival superficial layer cells decresed.Middle layer of cells：the average of density of patients with2diabetes is3097±284／mm~2, the average of density of control group is2957±199个／mm~2,P=0.057>0.05.Basal layer of cells: the average of density of patients with2diabetes is4423±214／mm~2, the average of density of control group is4415±220／mm~2,P=0.900>0.05.Mid cells conjunctival goblet cell is bigger and its form round or a kind ofcircle, whose reflectiveness is stronger, the body visible bright grain, clouds or arescattered the distribution in the shallow surface layer to the basal layer of the bullarconjunctiva。The average density of cells of patients with II diabetes is372±51／mm~2,the control group is424±24／mm~2，P=0.000<0,05, Difference Has StatisticsSignificance.the density of Conjunctival goblet cells of patients with2diabetesdecreased,which has inverse correlation with the course of disease.Conjunctival micro blood flow velocity with II diabetes changed:Patients with2diabetes had29abnormal eyes(82.85%);the control group has4abnormaleyes(20%).P=0.00<0.05, Difference have statistical significance. Conjunctivalmicrovascular of the2diabetes group can be seen more grain, grain flow, grain, grainflow and halt. grain flow, grain, grain flow and halt.The realtionship betwwen the density of conjunctival epithelial shallow cells andthe conjunctival microflow in the group of2diabetes:The2diabetes group had6eyeswhose conjunctival microflow were normal,the density of conjunctival epithelialshallow cells is1579±249／mm~2;29eyes had abnormal conjunctival microflow, thedensity of conjunctival epithelial shallow cells is1511±182／mm~2.P=0.441>0.05,Difference was no statistically significant.the changes of the density ofconjunctival epithelial shallow cells are of no correlation with the changes of the conjunctival microflow.The relationship between the density of the Conjunctival goblet cells and theconjunctival microflow in the2diabetes:7eyes had normal conjunctival microflow,the density of the Conjunctival goblet cells is327±42／mm~2;28eyes had abnormalconjunctival microflow, the density of the Conjunctival goblet cells is332±52／mm~2.P=0.846>0.05, Difference was no statistically significant. the changes of the densityof Conjunctival goblet cells are of no correlation with the changes of the conjunctivalmicroflow.The chages of the form of the Diabetes conjunctival microvascular:Blood vessellumen has two types: uniformity and uneven,the latter is abnormal.23abnormal eyesin the2diabetes group(65.71%),2abnormal eyes in the control group(10.00%).P=0.000<0.05,Difference was statistically significant,compared with the controlgroup,the vessle lumen of the patients with2diabetes can be observed moreuneven,and more microvessle lumen occlusion.The relationship between the microflow and the microvascular:6eyes in the2diabetes group had normal microvascular and abnormal microflow(41.67%);23eyeshad abnormal microvascular and abnormal microflow(100%).P=0.00<0.05,Differencewas statistically significant.part sick eye had abnormal microflow when theConjunctival microvascular was normal in the2diabetes group.compared with thenormal microflow group,the abnormal microvascular group can be seen moreabnormal microflow,and the abnormal ratio of the microflow is100%when theconjunctiva microvascular is abnormal.The relationship between condition of blood sugar control and the micro flow:1eye in the blood sugar controlled well group(Glycated hemoglobin:<6.2%) hadabnormal microflow；11eyes in the normal group (6.2～8.0％) had abnormalmicroflow,17eyes in the bad group(>8.0%)had abnormal microflow.Compared withthe normal group,accord to the fisher precise probality, P=0.003<0.05in the well group,difference was statistic significant.compared to the bad group, accord to thefisher precise probality, P=0.520>0.05in the normal group,difference was no statisticsignificant. The microflow in the normal group and the bad group had more grant andother abnormal microflow.The relationship between the conjunctival micrflow and the diabetic retinophy:5eyes which had abnormal microflow in the non diabetic retinopathy group of thedibetes group(62.50%),24eyes had abnormal microflow in the diabetic retinopathygroup(88.89%). P=0.082>0.05,difference was no statistic significant. Conjunctivalmicroflow had changed when there is no diabetic retinophy。The conjunctivalmicroflow changed before the changes of the diabetic retinopathy.The relationship between the bulbar conjunctiva microvascular abnormalities andthe diabetic retinophy:The number of diabetic group without diabetic retinopathybulbar conjunctiva microvascular abnormalities was0(0.00%),while diabeticretinopathy bulbar conjunctival microvascular abnormalities was23(85.18%).Therelationship between changes of Conjunctival microvascular and the diabeticretinopathy.Accord to the fisher precise text P=0.00<0.05,differnce was statisticsignificant, conjunctival microvascular changed before diabetic retinopathy.The relationship between the stages of the diabetic retinopathy:NPDR、PPDRand PDR and the Conjunctival mocroflow:9eyes had abnormal microflow in thePPDR(90.00%),7eyes had abnormal microflow in the DPDR(77.77%),8eyes hadabnormal microflow (100%).P=0.343>0.05,differencies were no statistic significantamong groups.so the abnormal microflow had no correlation with the stages of thediabetic retinopathy.The relationship between the stages of diabetic retinopathy and the Conjunctivalmicrovascular:8eyes had abnormal conjunctival microvascular in the DPDR(80%),7eyes had abnormal conjunctival microvascular in the PPDR(77.77%),8eyes hadabnormal conjunctival microvascular in the PDR(100%).P=0.369>0.05,differencies were no statistic significant among groups.so the abnormal microflow had nocorrelation with the stages of the diabetic retinopathy.Conclusion: Laser confocal microscope is an effective tool to research2diabetes conjunctival change,to understand diabetes ocular surface pathologicalchanges,which has important value to observe the diabetes conjunctival microflowand capillaries,which has certain guiding value to predict diabetic retinopathy andunderstand the changes of micro-circulation of diabetes.