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Corneal endothelium and central corneal thickness changes in type 2 diabetes mellitus

Authors El-Agamy A, Alsubaie S

Received 31 October 2016

Accepted for publication 30 November 2016

Published 2 March 2017 Volume 2017:11 Pages 481—486

DOI https://doi.org/10.2147/OPTH.S126217

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

Peer reviewer comments 2

Editor who approved publication: Dr Scott Fraser

Amira El-Agamy,1,2,* Shams Alsubaie3,*

1Department of Optometry and Vision Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia; 2Mansoura Ophthalmic Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt; 3Department of Optometry and Vision Sciences, Sulaiman Al Habib Hospital, Riyadh, Saudi Arabia

*These authors contributed equally to this work

Purpose: This study was conducted to compare the corneal endothelial cell density (ECD), morphological features, and central corneal thickness (CCT) in type 2 diabetes mellitus (DM) with age-matched, nondiabetic control subjects using EM-3000 Specular Microscope.
Study design: This was a prospective, hospital-based, nonrandomized, case–control, observational, and quantitative study.
Subjects and methods: The study included 57 patients (57 eyes) with type 2 DM and 45 control (nondiabetic) subjects (45 eyes). The corneal endothelial structure and CCT were examined in all eyes by noncontact specular microscopy using EM-3000 Specular Microscope. The endothelial structure was studied for ECD, coefficient of variation of cell area (CV), and percentage of hexagonal cells.
Results:
The study included 36 eyes without diabetic retinopathy (DR), 14 eyes with nonproliferative DR, and 7 eyes with proliferative DR. There were 26 eyes with a duration of ≤10 years and 31 eyes with a duration of >10 years. Also, there were 24 eyes with HbA1c ≤7.5% and 33 eyes with HbA1c >7.5%. ECD was significantly lower in the diabetic cornea than in control group (P=0.014). CV was higher in diabetic cornea (P=0.008). The diabetic cornea group had lower percentage of hexagonal cells than the control group, but the difference was not statistically significant (P=0.603). Also, diabetic cornea was thicker than control group, but not statistically significant (P=0.301).
Conclusion: This study documented that type 2 DM causes a significant reduction of ECD and increased CV (polymegathism). Also, diabetic cornea has increased CCT and lower percentage of hexagonal cells than normal subjects, but without statistical significance.

Keywords: endothelial cell density, central corneal thickness, diabetes mellitus, diabetic retinopathy, noncontact specular microscopy

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