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Machalińska A, Kuligowska A, Ziontkowska-Wrzałek A, Stroynowska B, Pius-Sadowska E, Safranow K, Machaliński J, Mozolewska-Piotrowska K, Machaliński B. The Severity of Diabetic Retinopathy Corresponds with Corneal Nerve Alterations and Ocular Discomfort of the Patient. Int J Mol Sci 2024; 25:6072. [PMID: 38892258 PMCID: PMC11173272 DOI: 10.3390/ijms25116072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 05/25/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024] Open
Abstract
Diabetic retinopathy (DR) remains the leading cause of blindness in the working-age population. Its progression causes gradual damage to corneal nerves, resulting in decreased corneal sensitivity (CS) and disruption of anterior-eye-surface homeostasis, which is clinically manifested by increased ocular discomfort and dry eye disease (DED). This study included 52 DR patients and 52 sex- and age-matched controls. Ocular Surface Disease Index (OSDI) survey, tear film-related parameters, CS, and in vivo corneal confocal microscopy (IVCM) of the subbasal plexus were performed. Furthermore, all patients underwent tear sampling for neurotrophin and cytokine analysis. OSDI scores were greater in DR patients than in controls (p = 0.00020). No differences in the Schirmer test score, noninvasive tear film-break-up time (NIBUT), tear meniscus or interferometry values, bulbar redness, severity of blepharitis or meibomian gland loss were found. In the DR group, both the CS (p < 0.001), and the scotopic pupil diameter (p = 0.00008) decreased. IVCM revealed reduced corneal nerve parameters in DR patients. The stage of DR was positively correlated with the OSDI (Rs = +0.51, 95% CI: + 0.35-+0.64, p < 0.001) and negatively correlated with IVCM corneal nerve parameters and scotopic pupillometry (Rs = -0.26, 95% CI: -0.44--0.06, p = 0.0097). We found negative correlations between the OSDI and IVCM corneal innervation parameters. The DR group showed lower tear film-brain-derived neurotrophic factor (BDNF) levels (p = 0.0001) and no differences in nerve growth factor (NGF)-β, neurotrophin (NT)-4, vascular endothelial growth factor (VEGF), interleukin (IL)-1β, IL-4, IL-5, IL-6, or IL-12 concentrations. Tumor necrosis factor (TNF)-α, IL-2, IL-8, IL-10, granulocyte macrophage colony-stimulating factor (GM-CSF), and interferon (IFN)-γ levels were decreased among patients with DR. Corneal innervation defects have a direct impact on patients' subjective feelings. The evolution of DR appears to be associated with corneal nerve alterations, emphasizing the importance of IVCM.
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Affiliation(s)
- Anna Machalińska
- First Department of Ophthalmology, Pomeranian Medical University, Al. Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland; (A.K.); (A.Z.-W.); (B.S.); (J.M.); (K.M.-P.)
| | - Agnieszka Kuligowska
- First Department of Ophthalmology, Pomeranian Medical University, Al. Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland; (A.K.); (A.Z.-W.); (B.S.); (J.M.); (K.M.-P.)
| | - Alicja Ziontkowska-Wrzałek
- First Department of Ophthalmology, Pomeranian Medical University, Al. Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland; (A.K.); (A.Z.-W.); (B.S.); (J.M.); (K.M.-P.)
| | - Beata Stroynowska
- First Department of Ophthalmology, Pomeranian Medical University, Al. Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland; (A.K.); (A.Z.-W.); (B.S.); (J.M.); (K.M.-P.)
| | - Ewa Pius-Sadowska
- Department of General Pathology, Pomeranian Medical University, Al. Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland; (E.P.-S.); (B.M.)
| | - Krzysztof Safranow
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, Al. Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland;
| | - Jan Machaliński
- First Department of Ophthalmology, Pomeranian Medical University, Al. Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland; (A.K.); (A.Z.-W.); (B.S.); (J.M.); (K.M.-P.)
| | - Katarzyna Mozolewska-Piotrowska
- First Department of Ophthalmology, Pomeranian Medical University, Al. Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland; (A.K.); (A.Z.-W.); (B.S.); (J.M.); (K.M.-P.)
| | - Bogusław Machaliński
- Department of General Pathology, Pomeranian Medical University, Al. Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland; (E.P.-S.); (B.M.)
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Mvilongo C, Akono ME, Nkoudou D, Nanfack C, Nomo A, Dim R, Eballé AO. [Clinical profile of corneal sensitivity in diabetic patients: A case-control study]. J Fr Ophtalmol 2024; 47:104212. [PMID: 38788250 DOI: 10.1016/j.jfo.2024.104212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 02/10/2024] [Accepted: 03/26/2024] [Indexed: 05/26/2024]
Abstract
PURPOSE To evaluate the corneal sensitivity of black diabetic patients and identify factors associated with changes in corneal sensitivity. METHODOLOGY We conducted a cross-sectional comparative case-control study at the National Obesity Center of the Yaounde Central Hospital and the Djoungolo District Hospital from March 1 to July 31, 2022. Corneal sensitivity was measured using the Cochet-Bonnet esthesiometer in all diabetic patients over 18 years of age, matched for age and sex to a clinically healthy control population. Data were analyzed using SPSS version 23.0 software. A P-value of less than 5% was considered significant. RESULTS A total of 111 diabetic and 111 non-diabetic patients participated in the study. The mean age was 53.46±12.74 years for diabetics and 52.85±11.77 years for non-diabetics (P=0.901). The mean duration of diabetes was 6.4±5.30 years. Corneal sensitivity in diabetics was lower (44.56±9.59mm) compared to non-diabetics (53.59±6.30mm) with a statistically significant difference (P=0.000). Factors associated with decrease in corneal sensitivity in diabetics were duration of diabetes and poor glycemic control. CONCLUSION Decrease in corneal sensitivity related to diabetes is a complication to be systematically screened for during the ophthalmologic follow-up of diabetic patients.
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Affiliation(s)
- C Mvilongo
- Service d'ophtalmologie, hôpital Central de Yaoundé, Yaoundé, Cameroun; Faculté de médecine de l'université de Yaoundé I, Yaoundé, Cameroun.
| | - M E Akono
- Service d'ophtalmologie, hôpital Central de Yaoundé, Yaoundé, Cameroun; Faculté de médecine de l'université de Yaoundé I, Yaoundé, Cameroun
| | - D Nkoudou
- Faculté de médecine de l'université de Yaoundé I, Yaoundé, Cameroun
| | - C Nanfack
- Faculté de médecine de l'université de Yaoundé I, Yaoundé, Cameroun; Service d'ophtalmologie, hôpital gyneco-obstétrique et pédiatrique de Yaoundé, Yaoundé, Cameroun
| | - A Nomo
- Faculté de médecine de l'université de Yaoundé I, Yaoundé, Cameroun; Service d'ophtalmologie, hôpital gyneco-obstétrique et pédiatrique de Yaoundé, Yaoundé, Cameroun
| | - R Dim
- Faculté de médecine de l'université de Yaoundé I, Yaoundé, Cameroun
| | - A O Eballé
- Faculté de médecine de l'université de Yaoundé I, Yaoundé, Cameroun; Service d'ophtalmologie, hôpital de District de Djoungolo/Olembe, Yaoundé, Cameroun
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Hashemi H, Ahmadi H, Rostami Z, Alishahi A, Heidari Z. The role of endothelial growth factor and tear levels in diabetic retinopathy in type 2 diabetes. Int Ophthalmol 2024; 44:143. [PMID: 38498296 DOI: 10.1007/s10792-024-03064-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 02/16/2024] [Indexed: 03/20/2024]
Abstract
PURPOSE To evaluate the tear level of VEGF and the quantity of tear film in type 2 diabetic patients. METHODS Thirty patients with diabetic retinopathy (DR group) and 30 patients with no DR (NDR group), and 30 healthy subjects with age and gender matching were enrolled in this prospective comparative study. The tear samples were collected using the Schirmer strips, and the amount of moisture absorbed by the strips was used to determine the quantitative level of the tear film. The concentration of VEGF in the tear samples was measured using the enzyme-linked immunosorbent assay method. The variables were compared with an independent t-test and covariance analysis. RESULTS Mean tear level of VEGF was significantly higher in DR group (235.42 pg/ml) compared to NDR (75.11 pg/ml) and control (58.77 pg/ml) groups (P ≤ 0.001). There was no significant difference in the mean of VEGF between NDR and control patients (P = 1.00). Mean quantitative tear film levels were 7.15%, 9.72%, and 15.11% in DR, NDR, and healthy subjects, respectively (P < 0.05). The pairwise analysis showed significant differences in the level of VEGF between DR and both NDR (P = 0.001) and normal (P = 0.017) groups. However, there was no significant difference observed between NDR and normal eyes (P = 0.743). CONCLUSION The VEGF level in tear was higher in diabetic patients with DR, independent of tear volume. The tear VEGF measurement can be used as a valuable predictor to prevent DR in diabetic patients.
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Affiliation(s)
- Hassan Hashemi
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran
| | - Hanieh Ahmadi
- Department of Ophthalmology, Faculty of Medicine, Bu-Ali Sina Hospital, Mazandaran University of Medical Sciences, Sari, Iran
| | - Zahra Rostami
- Department of Ophthalmology, Faculty of Medicine, Bu-Ali Sina Hospital, Mazandaran University of Medical Sciences, Sari, Iran
| | - Abbas Alishahi
- Department of Ophthalmology, Faculty of Medicine, Bu-Ali Sina Hospital, Mazandaran University of Medical Sciences, Sari, Iran
- Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Zahra Heidari
- Department of Ophthalmology, Faculty of Medicine, Bu-Ali Sina Hospital, Mazandaran University of Medical Sciences, Sari, Iran.
- Psychiatry and Behavioral Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Iran.
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Singer M, O'Brien P, Mein L, Olvera A. Corneal Sensitivity Is Inversely Correlated With Severity of Diabetic Retinopathy in a Predominantly Underrepresented Population. Am J Ophthalmol 2024; 259:53-61. [PMID: 37643714 DOI: 10.1016/j.ajo.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 04/18/2023] [Accepted: 08/16/2023] [Indexed: 08/31/2023]
Abstract
PURPOSE To assess the relationship between diabetic retinopathy (DR) and corneal sensitivity. METHODS In this prospective study, 100 eyes of 50 patients from primarily underrepresented racial and ethnic backgrounds with DR underwent assessment of corneal sensitivity using a Cochet-Bonnet esthesiometer. Severity of DR was graded by a masked reading center. Corneal sensitivity was compared in eyes with current or regressed proliferative DR (PDR) (n=35) and eyes with nonproliferative DR (NPDR) with no history of PDR (n=65). Corneal sensitivity in eyes that regressed from PDR to NPDR with anti-vascular endothelial growth factor (anti-VEGF) therapy (n=7) was compared to treatment-naïve eyes with no current or prior PDR (n=55) and to eyes with newly diagnosed, treatment-naïve PDR (n=12). RESULTS In eyes with current or prior PDR, the median corneal sensitivity (average of 4 quadrants) was 0.5 cm (interquartile range [IQR] 0-3.375), whereas in eyes with no current or prior PDR, the median corneal sensitivity was 4.75 cm (IQR 2.0-6.0, P < .0001). The median corneal sensitivity in eyes with regressed PDR was 0 cm (IQR 0-0.875), significantly lower than eyes with no current or prior PDR (4.5 cm, IQR 4.0, P = .0076) and no different than eyes with untreated PDR (0 cm, IQR 1.25). The odds of eyes with DR severity scale score ≥60 having complete corneal sensitivity loss was 3.6 times that of eyes with NPDR. CONCLUSIONS Corneal sensitivity is impaired in eyes with PDR compared to NPDR and is not rescued by anti-VEGF therapy. Assessment of corneal sensitivity in eyes with DR may identify patients at risk for additional complications, including neurotrophic keratopathy. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.
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Affiliation(s)
- Michael Singer
- From the University Medical Center Ophthalmology Associates (M.S., L.M.), San Antonio, Texas.
| | - Preston O'Brien
- University of the Incarnate Word School of Osteopathic Medicine (P.O.), San Antonio, Texas
| | - Luke Mein
- From the University Medical Center Ophthalmology Associates (M.S., L.M.), San Antonio, Texas
| | - Andrea Olvera
- University Medical Center Ophthalmology Associates, 9157 Huebner Road, San Antonio TX, 78240, USA
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Kiyat P, Kose T, Gümüstas B, Selver OB. Evaluation of Corneal Sensitivity and Quadrature Variability in Patients with Diabetic Neuropathy. Middle East Afr J Ophthalmol 2022; 29:200-204. [PMID: 38162562 PMCID: PMC10754107 DOI: 10.4103/meajo.meajo_111_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/07/2023] [Accepted: 09/13/2023] [Indexed: 01/03/2024] Open
Abstract
PURPOSE The purpose of the study was to evaluate the corneal sensitivity and its quadrature variability in patients with diabetic neuropathy (DN) diagnosed with electromyography and to compare these results with age- and sex-matched healthy individuals. METHODS The left eyes of 32 patients who applied for refraction or fundus examination and had a diagnosis of DN by electromyography in their medical history were included in this study. Corneal sensitivity was evaluated using the Cochet-Bonnet esthesiometer (Luneau, Paris) in five zones: central, nasal, superior, temporal, and inferior. The measurements of the patients were compared with the measurements of 32 age- and sex-matched healthy volunteers. Furthermore, the measurements of five corneal zones were compared with each other, and the level of correlation was investigated in each group. RESULTS The central corneal sensitivity values were measured as 4.12 ± 1.04 (mm) and 5.92 ± 0.14 (mm) (P < 0.001). While the sensitivity values at the superior, inferior, nasal, and temporal quadrants were detected as 5.85 ± 0.21, 5.85 ± 0.26, 5.94 ± 0.13, 5.93 ± 0.13, and 5.92 ± 0.14 (mm) in the control group, it was measured as 3.67 ± 0.66, 3.67 ± 0.62, 3.67 ± 0.62, and 3.89 ± 0.73 (mm) in the DN group, respectively. The corneal sensitivity values were all found to be significantly lower in the DN group (P < 0.001 for all parameters) at all quadrants as well as the central cornea. Furthermore, a moderate positive correlation between all five zones in the control group and a very strong positive correlation in the DN group were found in terms of the corneal quadrature sensitivity. CONCLUSION The current study revealed a significant reduction in corneal sensitivity in patients with DN. In both the control group and DN group, all corneal zones showed positive correlations which show the consistency of the measurement in different quadratures. Evaluating corneal sensitivity with a Cochet-Bonnet esthesiometer might serve as a useful screening tool in detecting neuropathy development. By taking the necessary precautions, further damage can be prevented.
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Affiliation(s)
- Pelin Kiyat
- Department of Ophthalmology, Buca Seyfi Demirsoy Training and Research Hospital, Izmir Democracy University, Izmir, Turkey
| | - Timur Kose
- Department of Biostatistics and Medical Informatics, Ege University, Izmir, Turkey
| | - Banu Gümüstas
- Department of Neurology, Buca Seyfi Demirsoy Training and Research Hospital, Izmir, Turkey
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Shah R, Amador C, Tormanen K, Ghiam S, Saghizadeh M, Arumugaswami V, Kumar A, Kramerov AA, Ljubimov AV. Systemic diseases and the cornea. Exp Eye Res 2021; 204:108455. [PMID: 33485845 PMCID: PMC7946758 DOI: 10.1016/j.exer.2021.108455] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/11/2021] [Accepted: 01/12/2021] [Indexed: 01/08/2023]
Abstract
There is a number of systemic diseases affecting the cornea. These include endocrine disorders (diabetes, Graves' disease, Addison's disease, hyperparathyroidism), infections with viruses (SARS-CoV-2, herpes simplex, varicella zoster, HTLV-1, Epstein-Barr virus) and bacteria (tuberculosis, syphilis and Pseudomonas aeruginosa), autoimmune and inflammatory diseases (rheumatoid arthritis, Sjögren's syndrome, lupus erythematosus, gout, atopic and vernal keratoconjunctivitis, multiple sclerosis, granulomatosis with polyangiitis, sarcoidosis, Cogan's syndrome, immunobullous diseases), corneal deposit disorders (Wilson's disease, cystinosis, Fabry disease, Meretoja's syndrome, mucopolysaccharidosis, hyperlipoproteinemia), and genetic disorders (aniridia, Ehlers-Danlos syndromes, Marfan syndrome). Corneal manifestations often provide an insight to underlying systemic diseases and can act as the first indicator of an undiagnosed systemic condition. Routine eye exams can bring attention to potentially life-threatening illnesses. In this review, we provide a fairly detailed overview of the pathologic changes in the cornea described in various systemic diseases and also discuss underlying molecular mechanisms, as well as current and emerging treatments.
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Affiliation(s)
- Ruchi Shah
- Eye Program, Board of Governors Regenerative Medicine Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | - Cynthia Amador
- Eye Program, Board of Governors Regenerative Medicine Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Kati Tormanen
- Center for Neurobiology and Vaccine Development, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Sean Ghiam
- Sackler School of Medicine, New York State/American Program of Tel Aviv University, Tel Aviv, Israel
| | - Mehrnoosh Saghizadeh
- Eye Program, Board of Governors Regenerative Medicine Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Departments of Molecular and Medical Pharmacology, Medicine, and Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Vaithi Arumugaswami
- Departments of Molecular and Medical Pharmacology, Medicine, and Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Ashok Kumar
- Department of Ophthalmology, Visual and Anatomical Sciences, Wayne State University, Detroit, MI, USA
| | - Andrei A Kramerov
- Eye Program, Board of Governors Regenerative Medicine Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Alexander V Ljubimov
- Eye Program, Board of Governors Regenerative Medicine Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Departments of Molecular and Medical Pharmacology, Medicine, and Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
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