Corneal endothelial cell density during diabetes mellitus and ocular diabetes complications treatment

Effect of Ablation Depth on the Endothelial Status of Eyes of Myopic Patients Undergoing Transepithelial Photorefractive Keratectomy: A Retrospective Study in Saudi Arabia

PURPOSE

The aim of this study was to correlate ablation depth on corneal endothelial cell (EC) indices following transepithelial photorefractive keratectomy (TPRK) in Saudi myopic patients.

METHODS

This was a retrospective cohort study of myopic eyes treated with TPRK. The changes in EC density and other indices were noted one week (W1) and 12 weeks (W12) after TPRK, which was the primary outcome. The laser ablation depth (AD) was correlated to the EC indices. The preoperative factors were also correlated to the outcomes using regression analysis to review predictors of change in the EC density.

RESULTS

We had 120 eyes of 60 myopic patients operated on for TPRK. The mean of maximum AD (Adm) and central AD (ADc) were 110.3±23.7 µ and 108.8±24.4 µ, respectively. The median change in EC count at W1 and W12 were -9.5 (interquartile range (IQR) -33.0, 17.0) and -3.0 (IQR -29.3, 13.3), respectively. The ADm was negatively correlated to a change in EC density at W1 (Wilcoxon (Z) =-2.7, P = 0.006) and at W12 (Z = -3.74, P <0.001). ADm (Kruskal-Wallis (K-W) test (P) = 0.167), ADc (K-W P = 0.08), central corneal thickness (K-W P = 0.65), and use of mitomycin-C (K-W P = 0.357) were not significant predictors of the change in EC density at W1. None of the variables significantly influenced the change in EC density at W12.

CONCLUSIONS

The corneal ablation depth for TPRK is correlated to changes in EC density at W1 and W12 after TPRK.

Association Between Endothelial Cell Density and Corneal Thickness in Medium, Short, and Long Eyes of Han Chinese Cataract Patients

PURPOSE

To evaluate the association between the endothelial cell density (ECD) and central corneal thickness (CCT) in medium, short, and long eyes of preoperative Han Chinese cataract patients.

DESIGN

Retrospective cross-sectional study.

METHODS

We consecutively enrolled 410 eyes, namely, 50 short eyes (axial length [AL]<22.0 mm), 150 medium eyes (22.0≤AL<24.0 mm), 120 medium-long eyes (24.0≤AL<26.0 mm), and 90 long eyes (AL≥26.0 mm), of 410 adult patients scheduled for cataract surgery. The ECD and CCT were determined preoperatively with a noncontact specular microscope. The association between the CCT and ECD was identified by using a multivariable regression analysis. A thin cornea was defined as having a CCT less than 500 µm.

RESULTS

After adjusting for age, the presence of arterial hypertension, the presence of diabetes mellitus, intraocular pressure, and AL, a positive association between the CCT and ECD was identified in short eyes (linear regression coefficient [B]=3.40; standardized B [β]=0.52; P = .03), medium eyes (B = 2.33; β=0.28; P = .002), medium-long eyes (B = 1.84; β=0.25; P = .02), and long eyes (B = 2.69; β=0.41; P = .04). In the total group, the multivariable logistic analysis showed a significant link between the presence of a thin cornea and a lower ECD (odds ratio [OR]=0.80 per 100 cells/mm2 increase; P = .001).

CONCLUSIONS

For cataract patients of Han ethnicity, a significant association between a thin CCT and a lower ECD was shown across the AL spectrum and was most prominent in short eyes. Eyes with a thin cornea are more likely to have a lower ECD.

Lacrimal gland Alterations and the Effect of artesunate on experimental induced diabetes rat models and related mechanisms

Diabetic patients are at high risk of developing lacrimal gland dysfunction, and the antimalarial drug artesunate (ART) was recently used to induce experimental-induced diabetes mellitus. This study's objective is to investigate the lacrimal gland alteration and the effect of ART on experimentally induced diabetes rat models and its related mechanisms. Forty rats were divided into five groups (8 rats/group): healthy control group (HC), diabetic group (DM), 50 mg/kg ART intervention diabetic group [DM + ART (50 mg/kg)], 100 mg/kg ART intervention diabetic group [DM + ART (100 mg/kg)] and 6 U/kg Insulin intervention diabetic group (DM + INS). The morphology of the eyeball and lacrimal gland tissues was determined using hematoxylin and eosin staining. In addition, external lacrimal glands were harvested for electronic microscopic examination, NFκB1, and TNF-α protein expression evaluation by immunohistochemistry and mRNA expression analysis by RT-PCR. Histopathological and ultrastructural changes suggest ART intervention has an improved structural effect. Protein expression of NFκB1 in the DM + ART (100 mg/kg) group was decreased. TNF-α significantly decreased in the DM + ART (50 mg/kg) and insulin groups. We concluded that ART improves structural changes in a lacrimal gland in diabetic rats. The present study provides further evidence of the therapeutic effect of ART on the lacrimal gland of diabetic rats by decreasing the expression of NFκB1 and TNF-α.

Topical Insulin for Ocular Surface Disease

Background: Insulin and insulin-like growth factor (IGF)-1 receptors are present in ocular tissues such as corneal epithelium, keratocytes, and conjunctival cells. Insulin plays a crucial role in the growth, differentiation, and proliferation of corneal epithelial cells, as well as in wound healing processes in various tissues. Purpose: This review explores the potential role of topical insulin in the treatment of ocular surface diseases. Specifically, it examines its impact on corneal nerve regeneration, sub-basal plexus corneal nerves, and its application in conditions like corneal epithelial defects, dry eye disease, and diabetic keratopathy. Methods: The review analyzes studies conducted over the past decade that have investigated the use of topical insulin in ocular surface diseases. It focuses on indications, drug preparation methods, side effects, efficacy outcomes, and variations in insulin concentrations and dosages used. Results: While off-label use of topical insulin has shown promising results in refractory corneal epithelial defects, its efficacy in dry eye disease is yet to be demonstrated. Variations in concentrations, dilutions, and dosing guidelines have been reported. However, limited data on ocular penetration, ocular toxicity, and systemic side effects pose challenges to its widespread utility. Conclusion: This review synthesizes findings from ocular investigations on topical insulin to assess its potential applicability in treating ocular surface and corneal diseases. By highlighting indications, preparation methods, side effects, and efficacy outcomes, it aims to provide insights into the current status and future prospects of using topical insulin in ophthalmic practice.

Long-term dynamic changes and influencing factors of corneal morphology after multiple intravitreal injections of anti-VEGF drugs

To observe alterations in corneal morphology caused by repeated intravitreal injections of anti-vascular endothelial growth factor (VEGF). Prospective cohort study. Seventy-seven eyes were treated with intravitreal injection of anti-VEGF from June 2021 to March 2023. There were 25 eyes of neovascular age-related macular degeneration (nAMD), 24 eyes of diabetic macular edema (DME), and 28 eyes of retinal vein occlusion (RVO). Aflibercept was used in 37 eyes and Ranibizumab was used in 40 eyes. 3 + PRN was used. Corneal endothelium and corneal thickness were measured using a corneal endothelial microscope. The data related to central corneal thickness, corneal endothelial cell density (ECD), average cell size, coefficient of variation (CV), proportion of hexagonal cells (Hex%) was collected. A comparison was also made between baseline and the dynamic changes of all indexes 1 year following the last injection. It was observed that in comparison to baseline, ECD and Hex% decreased significantly after the 3rd injection of Aflibercept and Ranibizumab. However, ECD did not decrease further and remained at the same level as after the last injection. Hex% and average cell size increased to a certain extent in comparison to the last injection. All the changes were found to be statistically significant (P < .01). After 3 injections, ECD in DME group was markedly lower than that in nAMD and RVO group, but the CV in DME group was higher than that in nAMD as well as RVO groups, and all the differences were statistically significant (P < .05). Following intravitreal anti-VEGF therapy, DME is more likely than other disorders to result in a decrease in ECD. Repeated intravitreal injections of anti-VEGF drugs can reduce the Hex% and ECD to a certain extent. After the last injection, Hex% can progressively recover, and ECD can remain stable without further declining. After injections, ECD in DME group was found to be significantly lower than that in nAMD and RVO groups, but CV in DME group was significantly higher in comparison to the other 2 groups. In patients with macular edema, repeated intravitreal injections of anti-VEGF may have certain effects on corneal morphology. Patients with diabetes mellitus in particular should pay special attention to corneal safety following repeated intravitreal injections if they have significantly reduced ECD at baseline.

Rat Model of Type 2 Diabetes Mellitus Recapitulates Human Disease in the Anterior Segment of the Eye

Changes in the anterior segment of the eye due to type 2 diabetes mellitus (T2DM) are not well-characterized, in part due to the lack of a reliable animal model. This study evaluates changes in the anterior segment, including crystalline lens health, corneal endothelial cell density, aqueous humor metabolites, and ciliary body vasculature, in a rat model of T2DM compared with human eyes. Male Sprague-Dawley rats were fed a high-fat diet (45% fat) or normal diet, and rats fed the high-fat diet were injected with streptozotocin i.p. to generate a model of T2DM. Cataract formation and corneal endothelial cell density were assessed using microscopic analysis. Diabetes-related rat aqueous humor alterations were assessed using metabolomics screening. Transmission electron microscopy was used to assess qualitative ultrastructural changes ciliary process microvessels at the site of aqueous formation in the eyes of diabetic rats and humans. Eyes from the diabetic rats demonstrated cataracts, lower corneal endothelial cell densities, altered aqueous metabolites, and ciliary body ultrastructural changes, including vascular endothelial cell activation, pericyte degeneration, perivascular edema, and basement membrane reduplication. These findings recapitulated diabetic changes in human eyes. These results support the use of this model for studying ocular manifestations of T2DM and support a hypothesis postulating blood-aqueous barrier breakdown and vascular leakage at the ciliary body as a mechanism for diabetic anterior segment pathology.

How does exosome cause diabetes?

Exosomes are extracellular vesicles that are widely distributed in multiple cell types and circulating body fluids. They have a specific effect on the target cells by releasing different vesicle contents. They have recently been recognized as important means of intercellular communication, being involved, for example, in the development of diabetes by increasing β-cell apoptosis, activating autoimmunity, and regulating cytokines to affect islet β-cell function and insulin sensitivity. An in-depth study of the role of exosome in the pathogenesis of diabetes may therefore provide a novel means of diagnosing and treating diabetes. In this review, we detail how exosome is involved in the development of diabetes.

Long-Term Real-World Outcomes of Corneal Changes in Proliferative Diabetic Retinopathy: Panretinal Photocoagulation vs. Intravitreal Conbercept

PURPOSE

To compare long-term real-world outcomes of corneal thickness (CT) alterations in proliferative diabetic retinopathy (PDR) patients treated with panretinal photocoagulation (PRP) and intravitreal conbercept (IVC).

METHODS

This retrospective study included 69 eyes of 69 patients with PDR (42 PRP and 27 IVC). Full corneal thickness (FCT), corneal epithelial thickness (CET) and corneal stromal thickness (CST) measured by anterior segment optical coherence tomography at baseline were compared between groups. These CT changes at last follow-up from baseline were also compared between groups and within each group.

RESULTS

During a mean follow-up of more than two years, the IVC group demonstrated a significantly increased corneal thickness from baseline compared to the PRP group in some areas (PRP vs. IVC: FCT 0-2 mm: -0.59 ± 9.31 vs. 5.59 ± 9.23 μm, p = 0.009; CST 0-2 mm: -2.05 ± 8.79 vs. 3.48 ± 7.52 μm, p = 0.015; CST 2-5 mm: -1.78 ± 13.27 vs. 5.68 ± 14.53 μm, p = 0.046). In within-group comparisons, a significantly increased FCT from baseline was found in the 0-2 mm area in the IVC group (p = 0.004), but no significant change was observed in the PRP group (p = 0.691). For CET changes, a significantly increased CT was observed in the 0-2 mm, 2-5 mm and 5-7 mm areas in both groups respectively (all p < 0.05). Regarding CST, an increased CT was found in the 0-2 mm area in the IVC group (p = 0.037), while a decreased trend was observed in 0-2 mm and 2-5 mm areas in the PRP group (all p > 0.05).

CONCLUSION

When using PRP or IVC in the long-term management of PDR, CT changes should be considered. This may provide evidence for corneal protection during PDR treatment.

Early effects of intravitreal anti-VEGF agents on cornea and visual acuity in patients with diabetic retinopathy

PURPOSE

This study aimed to investigate the early effects of intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents on the cornea and visual acuity in patients with diabetic retinopathy (DR).

METHODS

This retrospective study enrolled patients who were administered conbercept or ranibizumab to treat DR. Fundus photograph, fluorescein angiograph, and optical coherence tomography were preoperatively performed. The patients were classified into two groups: nonproliferative DR (NPDR) and PDR. Best-corrected visual acuity (BCVA), specular microscopy, central corneal thickness (CCT), and intraocular pressure were obtained before injection and at 1 day and 7 days after injection. The effects of anti-VEGF agents on BCVA and CCT were compared between the groups receiving conbercept and ranibizumab and between NPDR and PDR eyes.

RESULTS

A total 38 eyes (30 patients) were enrolled in this study. Twenty-one eyes received conbercept, and 17 eyes received ranibizumab. Twenty eyes were classified as NPDR and 18 eyes as PDR. No significant differences were found between the groups receiving conbercept and ranibizumab in the increase in BCVA nor in the increase of CCT at 1 day and 7 days after injection. As compared with NPDR eyes, PDR eyes demonstrated a significantly greater increase in CCT (-5.3 ± 3.7 vs. 6.5 ± 2.9 μm, P = 0.02 < 0.05) but not in BCVA (P = 0.33) at 1 day after injection. At 7 days after injection, no significant differences were found in the increase in BCVA nor in the increase of CCT between NPDR eyes and PDR eyes.

CONCLUSION

Intravitreal administration of anti-VEGF agents could cause a small but significant greater increase in CCT in PDR than in NPDR eyes in the early period. In patients with DR, no significant difference was found between conbercept and ranibizumab in the early effects on the visual acuity nor in the cornea.

Analysis of Corneal and Lens Densitometry Changes in Patients With Type 1 Diabetes Mellitus

PURPOSE

By comparing the densitometry findings of patients with type 1 diabetes mellitus (T1DM) and the healthy group, we aimed to understand the possible changes that may occur in the cornea and lens in those with diabetes mellitus (DM).

DESIGN

Prospective, cross-sectional study.

METHODS

A total of 60 eyes of 60 patients with T1DM and 101 eyes of 101 healthy subjects were included in this study. A complete ophthalmologic evaluation was performed in all participants. Scheimpflug tomography was performed to record the corneal and lens densitometry and other tomographic data. Mean glycosylated hemoglobin (HbA1c) and mean DM duration were recorded.

RESULTS

The mean age of the patients with T1DM and patients in the control group was 29.93 ± 8.56 years and 27.27 ± 1 4.96 years, respectively. The mean HbA1c was 8.43 ± 1.92, and the mean DM duration was 14.10 ± 7.77 years. Corneal densitometry (CD) values were significantly higher in the 0- to 2-mm zone in all layers and in the anterior and central 6- to 10-mm zone in the diabetic group (P = .03, P = .018, P = .001, P = .000, P = .004). The mean crystalline lens densitometry was higher in the T1DM group (P = .129). There were positive correlations between DM duration and CD in the anterior 0- to 2-mm (P = .043), central 6- to 10-mm (P = .016), posterior 6- to 10-mm (P = .022), and posterior 10- to 12-mm zone (P = .043).

CONCLUSIONS

CD values were significantly higher in the diabetic group. Diabetes duration and HbA1c values showed correlations with densitometry especially in the 6- to 10-mm corneal zone. Evaluation of the cornea with optical densitometry will be useful in the early diagnosis and follow-up of clinical structural and functional changes in the cornea.

Evaluation of the Corneal Endothelium Following Cataract Surgery in Diabetic and Non-Diabetic Patients

The aim of this study was to evaluate the influence of phacoemulsification cataract surgery on the state of the corneal endothelium in diabetic versus non-diabetic patients. We compared the corneal cell morphology in 48 diabetics with good glycemic control and 72 non-diabetic patients before and after uneventful phacoemulsification. Corneal cell density, central corneal thickness, and hexagonality were measured preoperatively and post-surgery (at 1 and 4 weeks) by specular microscopy. The effect of age, gender, axial length, and anterior chamber depth on the parameters of the corneal endothelium were evaluated. We noticed a drop in the endothelial density in both groups postoperatively: a mean endothelial cell loss of 472.7 ± 369.1 in the diabetic group was recorded versus 165.7 ± 214.6 mean loss in the non-diabetic group after the first week. A significant increase in central corneal thickness was also noticed in both groups one week after phacoemulsification, but no statistical significance after 4 weeks in the diabetic group. In terms of cell hexagonality, statistically significant differences were noticed after 4 weeks in both groups. Overall, a significant difference between diabetic and non-diabetic population was noticed in terms of corneal endothelial cell loss after uneventful phacoemulsification cataract surgery. Routine specular microscopy and HbA1c evaluation is recommended before cataract surgery, while intraoperative precautions and high monitorisation in terms of pacho power intensity and ultrasound energy, along with a proper application of the dispersive viscoelastic substances are essential to reduce the risk of endothelial damage.

Diabetic endothelial microangiopathy and pulmonary dysfunction

Type 2 diabetes mellitus (T2DM) is a widespread metabolic condition with a high global morbidity and mortality rate that affects the whole body. Their primary consequences are mostly caused by the macrovascular and microvascular bed degradation brought on by metabolic, hemodynamic, and inflammatory variables. However, research in recent years has expanded the target organ in T2DM to include the lung. Inflammatory lung diseases also impose a severe financial burden on global healthcare. T2DM has long been recognized as a significant comorbidity that influences the course of various respiratory disorders and their disease progress. The pathogenesis of the glycemic metabolic problem and endothelial microangiopathy of the respiratory disorders have garnered more attention lately, indicating that the two ailments have a shared history. This review aims to outline the connection between T2DM related endothelial cell dysfunction and concomitant respiratory diseases, including Coronavirus disease 2019 (COVID-19), asthma, chronic obstructive pulmonary disease (COPD) and idiopathic pulmonary fibrosis (IPF).

Diabetic retinopathy and corneal endothelial parameters: an analytical cross-sectional study

Background

To investigate the possible association of different pattern of diabetic retinopathy (DR) on corneal endothelium cells in type 2 diabetes mellitus patients.

Methods

In this descriptive-analytical cross-sectional study, corneal endothelium parameters including endothelial cell density (ECD), average cell size (AVG), coefficient of variation in cell size (CV), and hexagonality (Hex) were evaluated by non-contact specular microscopy.

Results

One hundred and thirty-four eyes of 134 diabetic patients including 77 females (57.5%) with a mean age of 61.03 ± 8.08 years were enrolled. The overall corneal parameters in diabetic patients with and without retinopathy were not significantly different (P > 0.05). There is a significant relationship between CV and the duration of the disease with age variable control (B = 0.369, p-value < 0.001).

Conclusions

Corneal endothelial parameters were not associated with DM in patients without and with DR. There is a significant relationship between CV and the duration of the disease with age variable control.

Post-COVID-19 Syndrome: Retinal Microcirculation as a Potential Marker for Chronic Fatigue

Post-COVID-19 syndrome (PCS) is characterized by persisting sequelae after infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). PCS can affect patients with all COVID-19 disease severities. As previous studies have revealed impaired blood flow as a provoking factor triggering PCS, it was the aim of the present study to investigate the potential association between self-reported chronic fatigue and retinal microcirculation in patients with PCS, potentially indicating an objective biomarker. A prospective study was performed, including 201 subjects: 173 patients with PCS and 28 controls. Retinal microcirculation was visualized by OCT angiography (OCT-A) and quantified using the Erlangen-Angio-Tool as macula and peripapillary vessel density (VD). Chronic fatigue (CF) was assessed according to the variables of Bell’s score, age and gender. VDs in the superficial vascular plexus (SVP), intermediate capillary plexus (ICP) and deep capillary plexus (DCP) were analyzed, considering the repetitions (12 times). Seropositivity for autoantibodies targeting G protein-coupled receptors (GPCR-AAbs) was determined by an established cardiomyocyte bioassay. Taking account of the repetitions, a mixed model was performed to detect possible differences in the least square means between the different groups included in the analysis. An age effect in relation to VD was observed between patients and controls (p < 0.0001). Gender analysis showed that women with PCS showed lower VD levels in the SVP compared to male patients (p = 0.0015). The PCS patients showed significantly lower VDs in the ICP as compared to the controls (p = 0.0001 (CI: 0.32; 1)). Moreover, considering PCS patients, the mixed model revealed a significant difference between those with chronic fatigue (CF) and those without CF with respect to VDs in the SVP (p = 0.0033 (CI: −4.5; −0.92)). The model included variables of age, gender and Bell’s score, representing a subjective marker for CF. Consequently, retinal microcirculation might serve as an objective biomarker in subjectively reported chronic fatigue in patients with PCS.

Hypertension secondary to nitric oxide depletion produces oxidative imbalance and inflammatory/fibrotic outcomes in the cornea of C57BL/6 mice

Arterial hypertension (AH) leads to oxidative and inflammatory imbalance that contribute to fibrosis development in many target organs. Here, we aimed to highlight the harmful effects of severe AH in the cornea. Our experimental model was established by administration of NG-nitro-L-arginine-methyl-ester (L-NAME) to C57BL/6 mice, which were monitored weekly for arterial blood pressure and intraocular pressure (IOP). Morphological studies of ocular tissues were accompanied by analyses of reactive oxygen species generation, and localization/expression of NAPDH oxidase isoforms (NOX1, NOX2, NOX4) and inflammatory biomarkers (PPARα, PPARγ, IL-1β, IL-6, IL-10, TNF-α, and COX-2). Masson's trichrome and Sirius Red staining were used to explore the fibrotic status of the cornea. The expression of collagen isoforms (COL1α1, COL1α2, COL3α1, COL4α1, COL4α2) and relevant metalloproteinases (MMPs) and their tissue inhibitors (TIMPs) were also quantified to evaluate the participation of collagen metabolism in AH-related corneal damage. Hypertensive animals showed an increase in IOP values, and a thinner cornea compared with normotensive controls. Moreover, AH increased NADPH oxidase activity and reactive oxygen species generation in the cornea, which was accompanied by transcriptional upregulation of NOX isoforms and inflammatory biomarkers, while reducing PPAR expression. L-NAME-treated animals also developed corneal fibrosis with overexpression of collagen isoforms and reduction of factors responsible for collagen degradation. This is the first study reporting structural changes in the cornea and elevated IOP in L-NAME-treated mice. Overexpression of the NADPH oxidase system and collagen deposition might play a substantial role in the pathogenic mechanisms contributing to ocular disturbances in a context of severe hypertension.

Corneal Endothelial Characteristics in Normal Chinese Han Children and Youngsters: A Study from the Specular Microscopy Descriptions

Objective

To observe the morphological changes of corneal endothelial cells in healthy Chinese children and youngsters and analyze the sensitive and specificity of the endothelial assessments.

Methods

14,670 Chinese healthy volunteers enrolled were examined by specular microscopy, and the endothelial descriptive indexes: the central corneal thickness (CCT), endothelial cell density (ECD), coefficient of variation in average cell size (CV), the percentage of regular hexagonal cells (hexagonality, HEX), cell size of minimal cell (S_min), cell size of maximal cell (S_max), average cell size (S_avg), and size of standard deviation of cell area (S_sd) as well as sex and age were analyzed.

Results

The average age of this study is 17.36 ± 7.58 (4–30) years. There is no sex predominance: 7,260 male (49.5%) and 7,410 female (50.5%). The mean CCT, ECD, CV, HEX, S_min/max, S_avg, and S_sd are 529.94 ± 31.53 (437–644) μm, 3,051.28 ± 375.49 (2,031–4,074) cells/mm², 28.34 ± 4.36 (18–40) %, 61.21 ± 10.29 (17–89) %, (147.79 ± 21.94 to 678.29 ± 120.96) μm², 332.74 ± 44.62 μm², and 95.02 ± 23.17 μm², respectively. The CCTs keep consistency. The ECD decreased rate is 1.02%/year. The curve of ECD and hexagonality expresses the same linear tender. The CCT and endothelial evaluation indexes have no sex predominant (p > 0.05); the quantitative indicators: CCT, ECD, and HEX are significant negative associated with age (p = 0.001 or p < 0.001); the variability indexes: the CV, S_min, S_max, S_avg, and S_sd are positive correlation (p < 0.001). The coefficients of CCT, HE, and S_min are -0.35, -0.59, and 1.17, respectively.

Conclusions

The ECD decrease rate is 1.02%/year of the normal Chinese Han childhood to the earlier adulthood. The ages 4 to 12, 13 to 20, and 21 to 30 can be named as the childhood, puberty and adulthood from endothelial biologic identity. The HEX is the sensitivity marks for the polymorphisms while the S _min is the specificity indicator CVs upon the Topcon Noncon Specular microscopy results.

High-Resolution Computer Tomography Image Features of Lungs for Patients with Type 2 Diabetes under the Faster-Region Recurrent Convolutional Neural Network Algorithm

The objective of this study was to adopt the high-resolution computed tomography (HRCT) technology based on the faster-region recurrent convolutional neural network (Faster-RCNN) algorithm to evaluate the lung infection in patients with type 2 diabetes, so as to analyze the application value of imaging features in the assessment of pulmonary disease in type 2 diabetes. In this study, 176 patients with type 2 diabetes were selected as the research objects, and they were divided into different groups based on gender, course of disease, age, glycosylated hemoglobin level (HbA1c), 2 h C peptide (2 h C-P) after meal, fasting C peptide (FC-P), and complications. The research objects were performed with HRCT scan, and the Faster-RCNN algorithm model was built to obtain the imaging features. The relationships between HRCT imaging features and 2 h C-P, FC-P, HbA1c, gender, course of disease, age, and complications were analyzed comprehensively. The results showed that there were no significant differences in HRCT scores between male and female patients, patients of various ages, and patients with different HbA1c contents (P > 0.05). As the course of disease and complications increased, HRCT scores of patients increased obviously (P < 0.05). The HRCT score decreased dramatically with the increase in the contents of 2 h C-P and FC-P after the meal (P < 0.05). In addition, the results of the Spearman rank correlation analysis showed that the course of disease and complications were positively correlated with the HRCT scores, while the 2 h C-P and FC-P levels after meal were negatively correlated with the HRCT scores. The receiver operating curve (ROC) showed that the accuracy, specificity, and sensitivity of HRCT imaging based on Faster-RCNN algorithm were 90.12%, 90.43%, and 83.64%, respectively, in diagnosing lung infection of patients with type 2 diabetes. In summary, the HRCT imaging features based on the Faster-RCNN algorithm can provide effective reference information for the diagnosis and condition assessment of lung infection in patients with type 2 diabetes.

The effects of acute angle closure crisis on corneal endothelial cells in patients with type 2 diabetes mellitus

OBJECTIVE

This study investigated the effects of acute angle closure crisis (AACC) on the corneal endothelial cells in patients with type 2 diabetes mellitus (DM) to identify the factors that cause corneal endothelial cell injury.

METHODS

We examined 154 patients who visited Qingdao Eye Hospital for AACC in one eye (154 eyes; 28 men and 126 women; mean age of 68 ± 8 years). We divided the participants into non-DM, DM well-control, and DM poor-control groups, with the unaffected eyes used as controls. Each participant was evaluated at the hospital while under AACC. We measured the relevant index and corneal parameters of the participants for statistical analysis.

RESULTS

There were significant statistical differences in corneal parameters among the three groups. The decreased levels of central endothelial cell density (CD) and the percentage of hexagonal cells (6A) were statistically relevant among the groups (P<0.05). The AACC duration was correlated with CD loss rate among the groups (P<0.05). The DM duration was correlated with CD loss rate in the DM well-control group. Compared with the non-DM group, the level of 6A decreased more significantly in the DM group after AACC (P<0.05). The AACC duration in the DM well-control group was significantly shorter than in the non-DM and DM poor-control groups (P<0.001). The DM poor-control group showed significantly worse visual acuity when compared with the other groups (P<0.05).

CONCLUSIONS

DM may impact the functional status of corneal endothelial cells. AACC can worsen the corneal endothelium damage in patients with DM. Blood glucose levels and the duration of intraocular hypertension are closely related to the severity of corneal endothelial injury.

Construction of lncRNA-related ceRNA regulatory network in diabetic subdermal endothelial cells

Long non-coding RNAs (lncRNAs) were considered to be involved in vascular complications in diabetes mellitus, but still only limited knowledge in this regard has been obtained. Herein, we further explored the roles of lncRNAs and mRNAs in diabetic vasculopathy (DV) through conducting bioinformatics analysis using data set downloaded from GEO database. The differentially expressed lncRNAs and mRNAs were identified by edge package. GO enrichment analysis and KEGG pathway analysis were performed based on clusterprofiler package. The relationship between lncRNA and miRNA was predicted using starBase database, and the potential mRNAs targeted by miRNAs were predicted by TargetScan, miRTarbase and miRDB database. The string database was used to analyze the protein-protein interaction (PPI). As a result, a total of 12 lncRNAs and 711 mRNAs were found to be differentially expressed in the diabetic subdermal endothelial cells compared with normal controls. A ceRNA network was established, which was composed of seven lncRNA nodes, 49 miRNA nodes, 58 mRNA nodes and 183 edges, and MSC-AS1 and LINC01550 may serve as key nodes. GO function enrichment analysis showed enrichments of epithelial cell proliferation, intercellular junction, and cell adhesion molecule binding. KEGG pathway analysis revealed 33 enriched pathways. PPI protein interaction analysis identified 57 potential ceRNA-related proteins. Overall, this study suggests that multiple lncRNAs, specifically MSC-AS1 and LINC01550, may play an important role in DV development and they are like to be developed as the therapeutic targets for DV. However, further experiments in vitro and in vivo should be conducted to validate our results.