Clinical Study Of Diabetic Ocular Surface And Corneal Diseases

Objective: To evaluate the damage of diabetes mellitus to ocular surface and cornea by examination of ocular surface and cornea of diabetic patients and healthy controls.Methods: We prospectively collected and analyzed 51 cases(102 eyes)of type 2diabetic patients(the diabetic group)and 34 cases(68 eyes)of non-diabetic controls(the control group)from the First Hospital of Dalian Medical University between June2015 and December 2015.The median age of diabetic group was 67(52-73)years,with a male: female ratio of 22(44 eyes): 29(58 eyes).The median age of control group was65(52-72)years,with a male: female ratio of 15(30 eyes): 19(38 eyes).All patients in diabetic group were underwent dilated fundus examination and fundus fluorescein angiography.According to the classification criteria of diabetic retinopathy(DR),the diabetic group was divided into three groups,comprising of non-retinopathy(NDR)group,non-proliferative diabetic retinopathy(NPDR)group and proliferative diabetic retinopathy(PDR)group.According to the duration of diabetes,the diabetic group was divided into two groups,comprising of the group of diabetic duration ?10 years and the group of diabetic duration >10 years.All subjects were finished questionnaire of dry eye and ocular surface disease index scale(OSDI),schrimer I test(SIt),tear break-up time(BUT),corneal fluorescein taining(FL),and corneal endothelial microscopy.Then,we compared discomfort symptoms of ocular surface,OSDI score,SIt value,BUT,FL positive rate,corneal endothelial cell density(CD),coefficient of variation(CV),hexagonal cell ratio(6A)and central corneal thickness(CCT)between different groups and evaluated the damage of diabetes mellitus to ocular surface and cornea.Results: Diabetic group showed obviously discomfort symptoms of ocular surface than control group(P<0.05).SIt value,BUT and CD in diabetic group showed low levels than those in control group(P<0.05).OSDI value,FL positive rate and CCT in diabetic group displayed high levels than in control group(P<0.05).However,CV and6 A had no significant difference between two groups(P>0.05).The group of diabetic duration ? 10 years exhibited remarkably ocular symptoms,such as dry eye,lachrymation,ophthalmodynia,compared to the group of diabetic duration >10 years(P < 0.05).Besides,other ocular discomfort symptoms were not associated with diabetic duration.ODSI value,FL positive rate were elevated in group of diabetic duration ?10 years than in group of diabetic duration >10 years(P<0.05).BUT,SIt value and CD were reduced in group of diabetic duration ?10 years than in group of diabetic duration > 10 years(P < 0.05).However,CV,6A and CCT showed no correlation with diabetic duration(P>0.05).Discomfort symptoms of ocular surface,such as dry eye,asthenopia,ocular cauterization,lachrymation and ophthalmodynia,exhibited remarkable difference between NDR group,NPDR group and PDR group(P<0.05).However,other ocular discomfort symptoms showed no significant correlation with the degree of diabetic retinopathy(P>0.05).ODSI value and FL positive rate displayed ascending tendency from NDR group,NPDR group to PDR group(P<0.05).However,BUT,SIt value,CD,and 6A showed descending tendency from NDR group,NPDR group to PDR group(P<0.05).CCT showed significant correlation with the degree of diabetic retinopathy(P<0.05),but presented as PDR group>NDR group>NPDR group,CV was not correlated with the degree of diabetic retinopathy(P>0.05).Conclusions: Patients with diabetes mellitus presented obviously discomfort symptoms of ocular surface which correlate significantly with diabetic duration and the degree of diabetic retinopathy.Diabetes mellitus patients display reduced amount andstability of lacrimal secretion and evaluated FL positive rate,which also correlate significantly with diabetic duration and the degree of diabetic retinopathy.Declined corneal endothelial cell density and increased central corneal thickness were presented in diabetes mellitus patients which correlated significantly with diabetic duration and the degree of diabetic retinopathy.Increased central corneal thickness were presented in diabetes mellitus patients which correlated significantly with the degree of diabetic retinopathy.No significant difference was displayed in coefficient of variation and hexagonal cell ratio between diabetes mellitus and non-diabetes mellitus patients.