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Sagaltici DA, Kurt E, Seymenoglu RG, Mayali H, Hekimsoy Z. The Effect of Diabetic Retinopathy and Blood Glucose Regulation on Corneal Biomechanical Parameters. Curr Eye Res 2024; 49:792-797. [PMID: 38587365 DOI: 10.1080/02713683.2024.2338219] [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: 09/30/2023] [Accepted: 03/28/2024] [Indexed: 04/09/2024]
Abstract
PURPOSE The aim of this study was to evaluate the effects of different stages of diabetic retinopathy (DR) and metabolic control of blood glucose levels on corneal biomechanical parameters. METHODS Diabetic patients were categorized into three groups: no DR group, nonproliferative DR (NPDR) group, and proliferative DR (PDR) group. Of the 141 eyes examined, 40 belonged to the control group, 34 to no DR group, 34 to NPDR group, and 33 to PDR group. Using an Ocular Response Analyzer to measure corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann-correlated intraocular pressure (IOPg), and corneal-compensated IOP (IOPcc). IOP was assessed using a Tono-Pen, while central corneal thickness (CCT) was determined using an ultrasonic pachymeter. HbA1c levels were also recorded. We conducted comparisons among these groups across biomechanical parameters and IOP (tonopen), and CCT, while also investigating the impact of HbA1c levels on these parameters. RESULTS Among any groups show a statistically significant difference in CCT, IOP (tonopen), CH, CRF, IOPg, and IOPcc. In diabetic patients, CRF, CTT, and IOPg values were significantly higher in those with HbA1c levels ≥ 7 mg/dl than in those with HbA1c levels < 7 mg/dl (p = 0.009, p = 0.013, p = 0.038), respectively, while there was no statistically significant difference in IOPcc, CH, and IOP (tonopen). Linear regression analysis showed that CH was positively associated with CCT (p < 0.001) and negatively associated with IOPcc (p < 0.001), while CRF was positively associated with CCT (p < 0.001), HbA1c (p < 0.05), and negatively associated with diagnosis of DR (p < 0.05). CONCLUSION This study underscores the influence of metabolic control, as reflected by HbA1c levels, on corneal biomechanical parameters in diabetic patients, emphasizing the importance of monitoring and managing glycemic control in this population.
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Affiliation(s)
- Duygu Akbulut Sagaltici
- University of Health Sciences, Bagcilar Training and Research Hospital, Department of Ophthalmology, Istanbul, Turkey
| | - Emin Kurt
- Department of Ophthalmology, Manisa Celal Bayar University, Manisa, Turkey
| | | | - Huseyin Mayali
- Department of Ophthalmology, Manisa Celal Bayar University, Manisa, Turkey
| | - Zeliha Hekimsoy
- Department of Endocrinology and Metabolism, Manisa Celal Bayar University, Manisa, Turkey
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Ramm L, Spoerl E, Terai N, Herber R, Pillunat LE. Association Between Corneal Changes and Retinal Oximetry in Diabetes Mellitus. Clin Ophthalmol 2024; 18:1235-1243. [PMID: 38737594 PMCID: PMC11088381 DOI: 10.2147/opth.s456020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 04/21/2024] [Indexed: 05/14/2024] Open
Abstract
Purpose Diabetes mellitus (DM) causes different corneal changes that are associated with the severity of diabetic retinopathy. To identify the pathophysiological reasons for this, corneal tomography and optical densitometry (COD) were combined with retinal oximetry. Methods Patients with DM and healthy subjects were included in this pilot study. Spatially resolved corneal thickness and COD were assessed using the Pentacam HR (Oculus). The pachymetry difference (PACDiff) was calculated as an indicator of an increase in the peripheral corneal thickness. Oxygen saturation (SO2) of the retinal vessels was measured using the Retinal Vessel Analyzer (Imedos Systems UG). Subsequently, the associations between corneal and retinal parameters were analyzed. Results Data from 30 patients with DM were compared with those from 30 age-matched healthy subjects. In DM, arterial (P = 0.048) and venous (P < 0.001) SO2 levels were increased, and arteriovenous SO2 difference was decreased (P < 0.001). In patients, PACDiff was higher than that in healthy subjects (P < 0.05), indicating a stronger increase in peripheral corneal thickness. The COD was reduced in DM (P = 0.004). The PACDiff of concentric rings with a diameter of 4 mm (r = -0.404; P = 0.033) to 8 mm (r = -0.522; P = 0.004) was inversely correlated with the arteriovenous SO2 difference. Furthermore, PACDiff 4 mm was negatively associated with arterial SO2 (r = -0.389; P = 0.041), and the COD of the peripheral corneal areas correlated positive with arterial SO2 (COD total 10-12 mm: r = 0.408; P = 0.025). Conclusion These associations might indicate a common pathogenesis of corneal and retinal changes in DM, which could be caused by reduced oxygen supply, mitochondrial dysfunction, oxidative stress, and cytokine effects.
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Affiliation(s)
- Lisa Ramm
- Department of Ophthalmology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, 01307, Germany
| | - Eberhard Spoerl
- Department of Ophthalmology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, 01307, Germany
| | - Naim Terai
- Department of Ophthalmology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, 01307, Germany
| | - Robert Herber
- Department of Ophthalmology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, 01307, Germany
| | - Lutz E Pillunat
- Department of Ophthalmology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, 01307, Germany
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Amorim M, Martins B, Fernandes R. Immune Fingerprint in Diabetes: Ocular Surface and Retinal Inflammation. Int J Mol Sci 2023; 24:9821. [PMID: 37372968 DOI: 10.3390/ijms24129821] [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: 05/09/2023] [Revised: 05/29/2023] [Accepted: 06/02/2023] [Indexed: 06/29/2023] Open
Abstract
Diabetes is a prevalent global health issue associated with significant morbidity and mortality. Diabetic retinopathy (DR) is a well-known inflammatory, neurovascular complication of diabetes and a leading cause of preventable blindness in developed countries among working-age adults. However, the ocular surface components of diabetic eyes are also at risk of damage due to uncontrolled diabetes, which is often overlooked. Inflammatory changes in the corneas of diabetic patients indicate that inflammation plays a significant role in diabetic complications, much like in DR. The eye's immune privilege restricts immune and inflammatory responses, and the cornea and retina have a complex network of innate immune cells that maintain immune homeostasis. Nevertheless, low-grade inflammation in diabetes contributes to immune dysregulation. This article aims to provide an overview and discussion of how diabetes affects the ocular immune system's main components, immune-competent cells, and inflammatory mediators. By understanding these effects, potential interventions and treatments may be developed to improve the ocular health of diabetic patients.
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Affiliation(s)
- Madania Amorim
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal
- Institute of Pharmacology and Experimental Therapeutics, Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal
| | - Beatriz Martins
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal
- Institute of Pharmacology and Experimental Therapeutics, Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3004-531 Coimbra, Portugal
| | - Rosa Fernandes
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal
- Institute of Pharmacology and Experimental Therapeutics, Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3004-531 Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), 3004-561 Coimbra, Portugal
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Morya AK, Ramesh PV, Kaur K, Gurnani B, Heda A, Bhatia K, Sinha A. Diabetes more than retinopathy, it’s effect on the anterior segment of eye. World J Clin Cases 2023; 11:3736-3749. [PMID: 37383113 PMCID: PMC10294174 DOI: 10.12998/wjcc.v11.i16.3736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 04/25/2023] [Accepted: 05/06/2023] [Indexed: 06/02/2023] Open
Abstract
Diabetes mellitus (DM) is one of the chronic metabolic noncommunicable diseases that has attained worldwide epidemics. It threatens healthy life around the globe, with mild-to-severe secondary complications and leads to significant illness including nephropathy, neuropathy, retinopathy, and macrovascular abnormalities including peripheral vasculopathy, and ischaemic heart disease. Research into diabetic retinopathy (DR), which affects one-third of persons with diabetes, has made considerable strides in recent years. In addition, it can lead to several anterior segment complications such as glaucoma, cataract, cornea, conjunctiva, lacrimal glands and other ocular surface diseases. Uncontrolled DM also caused gradual damage to corneal nerves and epithelial cells, which raises the likelihood of anterior segment diseases including corneal ulcers, dry eye disease, and chronic epithelial abnormalities. Although DR and other associated ocular complications are well-known, the complexity of its aetiology and diagnosis makes therapeutic intervention challenging. Strict glycaemic control, early detection and regular screening, and meticulous management is the key to halting the progression of the disease. In this review manuscript, we aim to provide an in-depth understanding of the broad spectrum of diabetic complications in the anterior segment of the ocular tissues and illustrate the progression of diabetes and its pathophysiology, epidemiology, and prospective therapeutic targets. This first such review article will highlight the role of diagnosing and treating patients with a plethora of anterior segment diseases associated with diabetes, which are often neglected.
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Affiliation(s)
- Arvind Kumar Morya
- Department of Ophthalmology, All India Institute of Medical Sciences, Hyderabad 508126, Telangana, India
| | - Prasanna Venkatesh Ramesh
- Glaucoma and Research, Mahathma Eye Hospital Private Limited, Tennur, Trichy 620001, Tamil Nadu, India
| | - Kirandeep Kaur
- Pediatric Ophthalmology and Strabismus, Sadguru Netra Chikitsalaya, Sadguru Seva Sangh Trust, Janaki-Kund, Chitrakoot 485334, Madhya Pradesh, India
| | - Bharat Gurnani
- Cornea and Refractive Services, Sadguru Netra Chikitsalaya, Sadguru Seva Sangh Trust, Janaki- Kund, Chitrakoot 485334, Madhya Pradesh, India
| | - Aarti Heda
- Department of Ophthalmology, National Institute of Ophthalmology, Pune 411000, Maharashtra, India
| | - Karan Bhatia
- Department of Ophthalmology, Manaktala Eye and Maternity Home, Meerut 250001, Uttar Pradesh, India
| | - Aprajita Sinha
- Department of Ophthalmology, Worcestershire Acute Hospital, Worcestershire 01601, United Kingdom
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Lanza M, Mozzillo E, Boccia R, Fedi L, Di Candia F, Tinto N, Melillo P, Simonelli F, Franzese A. Analysis of Corneal Deformation in Paediatric Patients Affected by Maturity Onset Diabetes of the Young Type 2. Diagnostics (Basel) 2023; 13:diagnostics13081500. [PMID: 37189601 DOI: 10.3390/diagnostics13081500] [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: 03/16/2023] [Revised: 04/15/2023] [Accepted: 04/19/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND To evaluate corneal deformation in Maturity Onset Diabetes of the Young type 2 (MODY2), paediatric subjects were analysed using a Scheimpflug-based device. The purpose of this analysis was to find new biomarkers for MODY2 disease and to gain a better understanding of the pathogenesis of the disease. METHODS A total of 15 patients with genetic and metabolic diagnoses of MODY2 (mean age 12.8 ± 5.66 years) and 15 age-matched healthy subjects were included. The biochemical and anthropometric data of MODY2 patients were collected from clinical records, and a complete ophthalmic check with a Pentacam HR EM-3000 Specular Microscope and Corvis ST devices was performed in both groups. RESULTS Highest concavity (HC) deflection length, Applanation 1 (A1) deflection amplitude, and A1 deflection area showed significantly lower values in MODY2 patients compared to healthy subjects. A significant positive correlation was observed between Body Mass Index (BMI) and HC deflection area and between waist circumference (WC) and the following parameters: maximum deformation amplitude, HC deformation amplitude, and HC deflection area. The glycosylated hemoglobin level (HbA1c) showed a significant positive correlation with Applanation 2 time and HC time. CONCLUSIONS The obtained results show, for the first time, differences regarding corneal distortion features in the MODY2 population compared with healthy eyes.
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Affiliation(s)
- Michele Lanza
- Multidisciplinary Department of Medical Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, 80138 Naples, Italy
| | - Enza Mozzillo
- Department of Translational Medical Sciences, Regional Center of Pediatric Diabetes, Federico II University of Naples, 80131 Naples, Italy
| | - Rosa Boccia
- Multidisciplinary Department of Medical Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, 80138 Naples, Italy
| | - Ludovica Fedi
- Department of Translational Medical Sciences, Regional Center of Pediatric Diabetes, Federico II University of Naples, 80131 Naples, Italy
| | - Francesca Di Candia
- Department of Translational Medical Sciences, Regional Center of Pediatric Diabetes, Federico II University of Naples, 80131 Naples, Italy
| | - Nadia Tinto
- Department of Molecular Medicine and Medical Biotechnology, CEINGE Advanced Biotechnologies, Federico II University of Naples, 80131 Naples, Italy
| | - Paolo Melillo
- Multidisciplinary Department of Medical Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, 80138 Naples, Italy
| | - Francesca Simonelli
- Multidisciplinary Department of Medical Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, 80138 Naples, Italy
| | - Adriana Franzese
- Department of Translational Medical Sciences, Regional Center of Pediatric Diabetes, Federico II University of Naples, 80131 Naples, Italy
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Ramm L, Herber R, Lorenz G, Jasper CS, Pillunat LE, Pillunat KR. Evaluation of corneal biomechanical properties using the ocular response analyzer and the dynamic Scheimpflug-Analyzer Corvis ST in high pressure and normal pressure open-angle glaucoma patients. PLoS One 2023; 18:e0281017. [PMID: 36701409 PMCID: PMC9879466 DOI: 10.1371/journal.pone.0281017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 01/12/2023] [Indexed: 01/27/2023] Open
Abstract
PURPOSE To characterize differences in corneal biomechanics in high (HPG) and normal pressure (NPG) primary open-angle glaucoma, and its association to disease severity. METHODS Corneal biomechanical properties were measured using the Ocular Response Analyzer (ORA) and the dynamic Scheimpflug-Analyzer Corvis ST (CST). Disease severity was functionally assessed by automated perimetry (Humphrey field analyzer) and structurally with the Heidelberg Retina Tomograph. To avoid a possible falsification by intraocular pressure, central corneal thickness and age, which strongly influence ORA and CST measurements, group matching was performed. Linear mixed models and generalized estimating equations were used to consider inter-eye correlation. RESULTS Following group matching, 60 eyes of 38 HPG and 103 eyes of 60 NPG patients were included. ORA measurement revealed a higher CRF in HPG than in NPG (P < 0.001). Additionally, the CST parameter integrated radius (P < 0.001) was significantly different between HPG and NPG. The parameter SSI (P < 0.001) representing corneal stiffness was higher in HPG than in NPG. Furthermore, regression analysis revealed associations between biomechanical parameters and indicators of disease severity. In HPG, SSI correlated to RNFL thickness. In NPG, dependencies between biomechanical readings and rim area, MD, and PSD were shown. CONCLUSION Significant differences in corneal biomechanical properties were detectable between HPG and NPG patients which might indicate different pathophysiological mechanisms underlying in both entities. Moreover, biomechanical parameters correlated to functional and structural indices of diseases severity. A reduced corneal deformation measured by dynamic methods was associated to advanced glaucomatous damage.
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Affiliation(s)
- Lisa Ramm
- Department of Ophthalmology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Robert Herber
- Faculty of Medicine Carl Gustav Carus, Department of Ophthalmology, TU Dresden, Dresden, Germany
- * E-mail:
| | - Georg Lorenz
- Department of Ophthalmology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Carolin S. Jasper
- Department of Ophthalmology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Lutz E. Pillunat
- Department of Ophthalmology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Karin R. Pillunat
- Department of Ophthalmology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
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Zhao Y, Hu G, Yan Y, Wang Z, Liu X, Shi H. Biomechanical analysis of ocular diseases and its in vitro study methods. Biomed Eng Online 2022; 21:49. [PMID: 35870978 PMCID: PMC9308301 DOI: 10.1186/s12938-022-01019-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 07/13/2022] [Indexed: 12/25/2022] Open
Abstract
Ocular diseases are closely related to the physiological changes in the eye sphere and its contents. Using biomechanical methods to explore the relationship between the structure and function of ocular tissue is beneficial to reveal the pathological processes. Studying the pathogenesis of various ocular diseases will be helpful for the diagnosis and treatment of ocular diseases. We provide a critical review of recent biomechanical analysis of ocular diseases including glaucoma, high myopia, and diabetes. And try to summarize the research about the biomechanical changes in ocular tissues (e.g., optic nerve head, sclera, cornea, etc.) associated with those diseases. The methods of ocular biomechanics research in vitro in recent years are also reviewed, including the measurement of biomechanics by ophthalmic equipment, finite element modeling, and biomechanical analysis methods. And the preparation and application of microfluidic eye chips that emerged in recent years were summarized. It provides new inspiration and opportunity for the pathogenesis of eye diseases and personalized and precise treatment.
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Ohn K, Noh YH, Moon JI, Jung Y. Measurement of corneal biomechanical properties in diabetes mellitus using the Corvis ST. Medicine (Baltimore) 2022; 101:e30248. [PMID: 36086751 PMCID: PMC10980441 DOI: 10.1097/md.0000000000030248] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 07/13/2022] [Indexed: 11/26/2022] Open
Abstract
We sought to assess changes in corneal biomechanical parameters in patients with diabetes mellitus (DM) in comparison with those among healthy controls using Corvis ST (CST). The study group included 209 eyes from healthy control subjects and 33 eyes from diabetic subjects, respectively. Following an ophthalmological examination, measurements with CST were taken. Additionally, hemoglobin A1c and blood glucose values were collected. Results were then compared to those of the control group after adjusting for potential confounding factors, including age-, intraocular pressure (IOP)-, central corneal thickness (CCT)-, spherical equivalent (SE)- and axial length (AL). After adjusting for potential confounding factors, including the age, IOP, CCT, SE, and AL, patients with DM presented significantly lower whole-eye movement (WEM) (ms) values than patients without DM (21.71 ± 0.84 vs. 22.15 ± 0.64 ms; P < .001). There was a significant and negative correlation between WEM (ms) and hemoglobin A1c in DM patients (r = -0.733; P = .001). In univariate and multivariate general linear mixed model (GLMM) analyses, IOP (P < .001 and P < .001, respectively) and the presence of DM (P = .001 and P < .001, respectively) significantly affected WEM (ms). In DM, significant changes in corneal biomechanical properties were detectable. The DM group showed significantly less deformable cornea and sclera than did the normal controls, even after adjusting for age, IOP, CCT, SE, and AL. These findings may cause misinterpretation of IOP measurements in diabetic patients. Therefore, the measurement of corneal biomechanics should be taken into consideration in clinical practice.
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Affiliation(s)
- Kyoung Ohn
- Department of Ophthalmology, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Young Ho Noh
- Department of Ophthalmology, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jung Il Moon
- Department of Ophthalmology, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Younhea Jung
- Department of Ophthalmology, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Zhou T, Lee A, Lo ACY, Kwok JSWJ. Diabetic Corneal Neuropathy: Pathogenic Mechanisms and Therapeutic Strategies. Front Pharmacol 2022; 13:816062. [PMID: 35281903 PMCID: PMC8905431 DOI: 10.3389/fphar.2022.816062] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/27/2022] [Indexed: 12/27/2022] Open
Abstract
Diabetes mellitus (DM) is a major global public health problem that can cause complications such as diabetic retinopathy, diabetic neuropathy, and diabetic nephropathy. Besides the reporting of reduction in corneal nerve density and decrease in corneal sensitivity in diabetic patients, there may be a subsequent result in delayed corneal wound healing and increased corneal infections. Despite being a potential cause of blindness, these corneal nerve changes have not gained enough attention. It has been proposed that corneal nerve changes may be an indicator for diabetic neuropathy, which can provide a window for early diagnosis and treatment. In this review, the authors aimed to give an overview of the relationship between corneal nerves and diabetic neuropathy as well as the underlying pathophysiological mechanisms of corneal nerve fiber changes caused by DM for improved prediction and prevention of diabetic neuropathy. In addition, the authors summarized current and novel therapeutic methods for delayed corneal wound healing, nerve protection and regeneration in the diabetic cornea.
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Affiliation(s)
- Ting Zhou
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Allie Lee
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Amy Cheuk Yin Lo
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Jeremy Sze Wai John Kwok
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
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Abstract
Background/Aim. Complications of diabetes mellitus (DM) in the eye are the leading cause of blindness in the world. Although research on eye complications of DM is mainly focused on retinal damage, changes in the cornea are also associated with DM. Central corneal thickness (CCT) reflects the metabolic status of the cornea and is also affected by DM. Knowledge of CCT changes that occur within DM is important for accurate IOP measurement, diagnosis, and monitoring of patients with glaucoma. The aim of the study was to examine the effect of DM type 2 on the central corneal thickness. Methods. The study was designed as a clinical, cross-sectional, observational study. It consists of 96 patients, divided into two groups. The first group consisted of 49 patients diagnosed with DM type 2. The second group was the control group and consisted of 47 healthy subjects. The DM group was divided into subgroups depending on the status of diabetic retinopathy, the length of DM treatment, and the levels of glycosylated hemoglobin (HbA1C). Results. A statistically significant difference in CCT was observed among DM patients and the control group. Analyzing only DM patients, the highest CCT values were observed in patients who had HbA1C > 7.0%, as well as those who have treated DM for more than 15 years, with a statistically significant difference in relation to the corresponding patient sub-groups (p = 0.002 and p = 0.037, respectively). No statistically significant difference was observed depending on the status of retinopathy. Intraocular pressure (IOP) was statistically significantly higher in patients with DM compared to the control group. Conclusion. Our research demonstrated that the status of retinopathy had no statistically significant influence on CCT. Knowing that the increase in CCT also affects the measured IOP values, this research will be useful in better understanding and control of the patients who have glaucoma in addition to DM type 2.
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Ates KM, Estes AJ, Liu Y. Potential underlying genetic associations between keratoconus and diabetes mellitus. ADVANCES IN OPHTHALMOLOGY PRACTICE AND RESEARCH 2021; 1:100005. [PMID: 34746916 PMCID: PMC8570550 DOI: 10.1016/j.aopr.2021.100005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/18/2021] [Accepted: 08/29/2021] [Indexed: 12/14/2022]
Abstract
Background Keratoconus (KC) is the most common ectatic corneal disease, characterized by significantly localized thinning of the corneal stroma. Genetic, environmental, hormonal, and metabolic factors contribute to the pathogenesis of KC. Additionally, multiple comorbidities, such as diabetes mellitus, may affect the risk of KC. Main Body Patients with diabetes mellitus (DM) have been reported to have lower risk of developing KC by way of increased endogenous collagen crosslinking in response to chronic hyperglycemia. However, this remains a debated topic as other studies have suggested either a positive association or no association between DM and KC. To gain further insight into the underlying genetic components of these two diseases, we reviewed candidate genes associated with KC and central corneal thickness in the literature. We then explored how these genes may be regulated similarly or differentially under hyperglycemic conditions and the role they play in the systemic complications associated with DM. Conclusion Our comprehensive review of potential genetic factors underlying KC and DM provides a direction for future studies to further determine the genetic etiology of KC and how it is influenced by systemic diseases such as diabetes.
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Affiliation(s)
- Kristin M. Ates
- Department of Cellular Biology and Anatomy, Medical College of Georgia, Augusta University, Augusta, GA, USA
- Department of Ophthalmology, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Amy J. Estes
- Department of Ophthalmology, Medical College of Georgia, Augusta University, Augusta, GA, USA
- James and Jean Culver Vision Discovery Institute, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Yutao Liu
- Department of Cellular Biology and Anatomy, Medical College of Georgia, Augusta University, Augusta, GA, USA
- James and Jean Culver Vision Discovery Institute, Medical College of Georgia, Augusta University, Augusta, GA, USA
- Center for Biotechnology and Genomic Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
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12
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Bayat AH, Akpolat C. The change of anterior chamber angle parameters after cataract surgery in diabetic patients. Ther Adv Ophthalmol 2021; 13:25158414211034717. [PMID: 34409258 PMCID: PMC8365015 DOI: 10.1177/25158414211034717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 07/06/2021] [Indexed: 11/16/2022] Open
Abstract
Purpose: The purpose of this study is to investigate the change of anterior chamber angle morphology after cataract surgery in patients with type 2 diabetes mellitus (DM2) using anterior segment optical coherence tomography (AS-OCT). Methods: In this prospective and comparative study, 57 eyes of the patients with cataract were investigated. The patients were divided into two groups. The DM2 group included cataractous type 2 diabetic patients without diabetic retinopathy (n = 30) and the non-DM2 group included nondiabetic participants with cataract (n = 27). The AS-OCT examinations were performed at baseline and 1 month after the cataract surgery. The corrected distance visual acuity (CDVA), intraocular pressure (IOP), angle-opening distance at 500 µm (AOD-500) and trabecular iris space area at 500 µm (TISA-500), and scleral spur angle (SSA) in temporal quadrant were analyzed. Results: The mean age, sex, and axial length values were similar in both groups (p > 0.05 for all). The CDVA was significantly improved in both groups (p < 0.001). The mean AOD-500, TISA-500, and SSA were increased and the mean IOP was decreased after cataract surgery in both groups (p < 0.001 for all). There were not any statistically significant intergroup differences in CDVA, IOP, and AS-OCT measurements between the DM2 and non-DM2 groups (p > 0.05 for all). Conclusion: Cataract surgery showed significant increases in mean anterior chamber angle parameters and reductions in IOP values in both diabetic and nondiabetic patients without intergroup significant differences. These results suggested the safety and effectiveness of cataract surgery, especially regarding anterior chamber angle parameters and so IOP changes.
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Affiliation(s)
- Alper Halil Bayat
- Department of Ophthalmology, Esenler Hospital, Medipol University, Birlik Mah Bahçeler cad. no:5 Esenler 34320, Istanbul, Turkey
| | - Cetin Akpolat
- Department of Ophthalmology, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, 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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Abstract
PURPOSE Diabetes mellitus (DM) induces changes in corneal biomechanical properties. The influence of disease-specific factors was evaluated, and a novel DM index was created. METHODS Eighty-one patients with DM and 75 healthy subjects were matched according to age, intraocular pressure, and central corneal thickness. Information on the disease was collected, and measurements with the Ocular Response Analyzer and the Corvis ST were taken. Results were compared between the groups, and the influence of disease-specific factors was evaluated. From dynamic corneal response parameters, a DM index was calculated. RESULTS In DM, corneal hysteresis was higher than in healthy subjects (10.5 ± 1.9 vs. 9.7 ± 1.9 mm Hg, P = 0.008). In addition, dynamic corneal response parameters showed significant differences. Among others, highest concavity (HC) (17.212 ± 0.444 vs. 16.632 ± 0.794 ms, P < 0.001) and A2 time (21.85 ± 0.459 vs. 21.674 ± 0.447 ms, P = 0.017) as well as A1 (0.108 ± 0.008 vs. 0.104 ± 0.011 mm, P = 0.019) and A2 deflection amplitudes (0.127 ± 0.014 vs. 0.119 ± 0.014 mm, P < 0.001) were increased in DM. In DM type 1, HC deformation amplitude (1.14 ± 0.19 vs. 1.095 ± 0.114 mm, P = 0.035) was higher than in type 2. The time of deflection amplitude max correlated with the severity of retinopathy (R = 0.254, P= 0.023). In case of diabetic maculopathy, A1 velocity (0.155 ± 0.018 vs. 0.144 ± 0.019 ms, P = 0.043) and A2 time (22.052 ± 0.395 vs. 21.79 ± 0.46 ms, P = 0.04) were increased. Deformation amplitude max (R = 0.297, P = 0.024), HC time (R = 0.26, P = 0.049), HC deformation amplitude (R = 0.297, P = 0.024), and A2 deformation amplitude (R = 0.276, P = 0.036) were associated to disease duration. The DM index revealed a sensitivity of 0.773 and a specificity of 0.808 (area under the curve of receiver operating characteristic = 0.833). CONCLUSIONS In DM, changes in corneal biomechanics were correlated with disease-specific factors. The DM index achieved reliable sensitivity and specificity values.
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Yang Y, Ng TK, Wang L, Wu N, Xiao M, Sun X, Chen Y. Association of 24-Hour Intraocular Pressure Fluctuation With Corneal Hysteresis and Axial Length in Untreated Chinese Primary Open-Angle Glaucoma Patients. Transl Vis Sci Technol 2020; 9:25. [PMID: 33244445 PMCID: PMC7683862 DOI: 10.1167/tvst.9.12.25] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 10/12/2020] [Indexed: 02/05/2023] Open
Abstract
PURPOSE The purpose of this study was to evaluate the association of 24-hour intraocular pressure (IOP) fluctuation with corneal biomechanics and ocular biometric parameters in Chinese patients with primary open angle glaucoma (POAG) before initial treatment. METHODS Forty-nine Chinese patients with POAG (98 eyes) were recruited in this study before start of any POAG treatment. The 24-hour IOP was measured with a 2-hour interval by a noncontact tonometer. Corneal biomechanical properties and biometric parameters were measured once during 8 AM to 6 PM before 24-hour IOP measurement. RESULTS The 24-hour IOP fluctuation was defined as the differences between the peak and trough IOP measurement and was significantly associated with axial length (AL) in the multivariate analysis. The POAG subjects with AL ≤ 26 mm had significantly larger 24-hour IOP fluctuation but lower corneal hysteresis, compared to those with AL > 26 mm. In addition, subgroup analysis showed that high tension glaucoma subjects had larger 24-hour IOP fluctuation and higher corneal resistance factor than patients with normal tension glaucoma. CONCLUSIONS This study revealed the association of 24-hour IOP fluctuation with office hour corneal biomechanical properties and AL in patients with POAG. Their contributions to IOP fluctuation should be considered in the risk analysis of glaucoma development and progression. TRANSLATIONAL RELEVANCE Ocular biometric parameters are related with 24-hour IOP fluctuation in patients with POAG, which is potentially helpful in explaining different progression patterns in different types of patients.
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Affiliation(s)
- Yaping Yang
- Department of Ophthalmology and Visual Science, Eye and Ear Nose Throat Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Key Laboratory of Myopia, Ministry of Health, Fudan University, Shanghai, China
- Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China
| | - Tsz Kin Ng
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou University Medical College, Shantou, Guangdong, China
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Li Wang
- Department of Ophthalmology and Visual Science, Eye and Ear Nose Throat Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Key Laboratory of Myopia, Ministry of Health, Fudan University, Shanghai, China
- Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China
| | - Na Wu
- Department of Ophthalmology and Visual Science, Eye and Ear Nose Throat Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Key Laboratory of Myopia, Ministry of Health, Fudan University, Shanghai, China
- Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China
| | - Ming Xiao
- Department of Ophthalmology, Shanghai Bei Zhan Hospital, Shanghai, China
| | - Xinghuai Sun
- Department of Ophthalmology and Visual Science, Eye and Ear Nose Throat Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Key Laboratory of Myopia, Ministry of Health, Fudan University, Shanghai, China
- Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China
- State Key Laboratory of Medical Neurobiology, Institutes of Brain Science and Collaborative Innovation Center for Brain Science, Fudan University, Shanghai, China
| | - Yuhong Chen
- Department of Ophthalmology and Visual Science, Eye and Ear Nose Throat Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Key Laboratory of Myopia, Ministry of Health, Fudan University, Shanghai, China
- Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China
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Priyadarsini S, Whelchel A, Nicholas S, Sharif R, Riaz K, Karamichos D. Diabetic keratopathy: Insights and challenges. Surv Ophthalmol 2020; 65:513-529. [PMID: 32092364 PMCID: PMC8116932 DOI: 10.1016/j.survophthal.2020.02.005] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 02/10/2020] [Accepted: 02/11/2020] [Indexed: 12/11/2022]
Abstract
Ocular complications from diabetes mellitus are common. Diabetic keratopathy, the most frequent clinical condition affecting the human cornea, is a potentially sight-threatening condition caused mostly by epithelial disturbances that are of clinical and research attention because of their severity. Diabetic keratopathy exhibits several clinical manifestations, including persistent corneal epithelial erosion, superficial punctate keratopathy, delayed epithelial regeneration, and decreased corneal sensitivity, that may lead to compromised visual acuity or permanent vision loss. The limited amount of clinical studies makes it difficult to fully understand the pathobiology of diabetic keratopathy. Effective therapeutic approaches are elusive. We summarize the clinical manifestations of diabetic keratopathy and discuss available treatments and up-to-date research studies in an attempt to provide a thorough overview of the disorder.
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Affiliation(s)
- S Priyadarsini
- Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - A Whelchel
- Department of Physiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - S Nicholas
- Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - R Sharif
- Department of Cell Biology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - K Riaz
- Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - D Karamichos
- Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA; Department of Cell Biology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
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Wang X, Xu G, Wang W, Wang J, Chen L, He M, Chen Z. Changes in corneal biomechanics in patients with diabetes mellitus: a systematic review and meta-analysis. Acta Diabetol 2020; 57:973-981. [PMID: 32201905 DOI: 10.1007/s00592-020-01481-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 01/10/2020] [Indexed: 02/07/2023]
Abstract
AIMS To determine the changes in corneal biomechanical parameters in patients with diabetes mellitus (DM) in comparison with controls. METHODS Pertinent studies were identified by comprehensively search of PubMed, Embase, the Web of Science, the Cochrane Library, Scopus, the China National Knowledge Infrastructure and the Chinese biomedical disc (CBM) databases. Pooling analyses by random models using the D-L method were performed for corneal hysteresis (CH), the corneal resistance factor (CRF), corneal-compensated intraocular pressure (IOPcc) and Goldmann-correlated intraocular pressure (IOPg). RESULTS A total of 15 studies were included in the final analysis, involving 1506 eyes in the diabetic group and 2190 eyes in the control group. The diabetic group had significantly higher CH, CRF, IOPg and IOPcc values than the control group. The pooled mean differences were 1.34 mmHg (95% confidence interval [CI] 0.60-2.08 mmHg, P < 0.001) for IOPg and 0.85 mmHg (95% CI 0.18-1.51 mmHg, P = 0.013) for IOPcc, 0.38 mmHg (95% CI 0.01-0.75, P = 0.047) for CH and 0.63 mmHg (95% CI 0.27-0.98, P = 0.001) for the CRF. Sensitivity analyses using the leave-one-out method showed a consistent significant difference between the groups (all P < 0.001). CONCLUSIONS Corneal biomechanics changed in the patients with DM. High CH, CRF, IOPcc and IOPg values may be associated factors for diabetes mellitus. Future studies are warranted to clarify the underlying mechanisms and explore the relationship between corneal biomechanics, glaucoma and diabetes mellitus. REGISTRATION PROSPERO registration No CRD4201705465.
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Affiliation(s)
- Xiaoyi Wang
- Department of Ophthalmology Center, Huizhou Municipal Central Hospital, Huizhou, Guangdong Province, People's Republic of China
| | - Guihua Xu
- Department of Ophthalmology Center, Huizhou Municipal Central Hospital, Huizhou, Guangdong Province, People's Republic of China
| | - Wei Wang
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Juanjuan Wang
- Department of Ophthalmology Center, Huizhou Municipal Central Hospital, Huizhou, Guangdong Province, People's Republic of China
| | - Lili Chen
- Department of Ophthalmology Center, Huizhou Municipal Central Hospital, Huizhou, Guangdong Province, People's Republic of China
| | - Mingguang He
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Zilin Chen
- Department of Ophthalmology Center, Huizhou Municipal Central Hospital, Huizhou, Guangdong Province, People's Republic of China.
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Edris NA, Arfeen SA, Mosaad R, Nassar GA. Evaluation of Corneal Biomechanical Parameters in Psoriasis Patients: A Controlled Study. Clin Ophthalmol 2020; 14:1833-1837. [PMID: 32636611 PMCID: PMC7335276 DOI: 10.2147/opth.s256629] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 06/16/2020] [Indexed: 11/26/2022] Open
Abstract
Purpose To evaluate corneal biomechanical parameters with an ocular response analyzer (ORA) in patients with psoriasis and compare these parameters with age-matched control subjects. Study Design This was a cross-sectional observational case–control study. Methods Thirty eyes of 15 psoriasis patients were included in the study and compared with 30 eyes of 15 control subjects. Corneal biomechanical properties were calculated by ORA. Central corneal thickness (CCT) was measured by anterior-segment optical coherence tomography. The main outcome measures were corneal hysteresis (CH), corneal resistance factor (CRF), corneal-compensated intraocular pressure (IOPcc), and Goldmann-correlated IOP (IOPg). For dry-eye evaluation, Schirmer’s test was used. Results Mean CH in the psoriasis group was 10.20±1.55 mmHg and in the control group 10.66±1.36 mmHg (p=0.215). Mean CRF in the psoriasis group was 9.76±1.60 mmHg and in the control group 10.97±1.42 mmHg (p=0.003). Mean IOPcc in the psoriasis group was 14.84±3.43 mmHg and in the control group 16.67±3.17 mmHg (p=0.035). Mean IOPg in the psoriasis group was 13.92±3.35 mmHg and in the control group 16.62±3.10 mmHg (p=0.002). Mean CCT in the psoriasis group was 543.90±37.27 µm and in the control group 551.23±28.63 µm (p=0.392). Schirmer’s test results in the psoriasis group were 11.4±1.57 mm/5 min and in the control group 17.5±1.52 mm/5 min (p<0.001). Conclusion Psoriasis affects corneal biomechanical properties with statistically significantly lower corneal biomechanics than normal. CH correlates negatively with disease activity. These corneal biomechanical changes should be considered when determining IOP values and during corneal evaluation for keratoconus-suspected patients.
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Affiliation(s)
- Noha A Edris
- Ophthalmology Department, Cairo University, Faculty of Medicine, Cairo, Egypt
| | - Shaimaa A Arfeen
- Ophthalmology Department, Cairo University, Faculty of Medicine, Cairo, Egypt
| | - Rana Mosaad
- Dermatology Department, Cairo University, Faculty of Medicine, Cairo, Egypt
| | - Ghada A Nassar
- Ophthalmology Department, Cairo University, Faculty of Medicine, Cairo, Egypt
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Corneal Biomechanical Changes After Uneventful Phacoemulsification in Patients With Type 2 Diabetes Mellitus and Patients Without Diabetes. Cornea 2020; 39:1073-1079. [PMID: 32301813 DOI: 10.1097/ico.0000000000002332] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare corneal biomechanical changes after uneventful phacoemulsification cataract surgery between type 2 diabetic (DM) and nondiabetic patients. METHODS Forty-four diabetic (44 eyes) and 44 (44 eyes) age and sex-matched non-DM controls with age-related cataract were enrolled in this prospective observational study. Corneal hysteresis (CH), corneal resistance factor (CRF), and corneal-compensated intraocular pressure (IOPcc) were evaluated by using the ocular response analyzer; central corneal thickness was recorded by using the Pentacam HR. Patients were evaluated preoperatively and 1 and 6 months after surgery. RESULTS In the DM group, CH was observed to be significantly lower than preoperative value (9.8 ± 1.5 mm Hg) at 1 month (9.4 ± 1.2 mm Hg, P = 0.040), but not at the 6-month follow-up (9.6 ± 1.6 mm Hg, P = 0.437),whereas it did not change significantly in the non-DM group (preoperative 9.8 ± 1.3 mm Hg vs. 1 month 9.6 ± 1.1 mm Hg vs. 6 months 10.1 ± 1.1 mm Hg, P > 0.05). CRF was significantly lower than the preoperative values at 1 and 6 months in both groups (P ≤ 0.001). Postoperative CH change was significantly associated with preoperative CH (P < 0.001), preoperative IOPcc (P = 0.004), and IOPcc change (P < 0.001), whereas CRF change was only correlated with preoperative CRF (P < 0.001). There was a significant postoperative IOPcc reduction 6 months after surgery (P < 0.001) in both DM and non-DM groups; however, central corneal thickness was not found to significantly change in the postoperative period (P > 0.05). CONCLUSIONS This study showed that phacoemulsification causes a significant and persistent decrease in intraocular pressure and CRF in both groups, whereas CH recovered to preoperative values, although more slowly in patients with diabetes.
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Richdale K, Chao C, Hamilton M. Eye care providers' emerging roles in early detection of diabetes and management of diabetic changes to the ocular surface: a review. BMJ Open Diabetes Res Care 2020; 8:8/1/e001094. [PMID: 32299899 PMCID: PMC7199150 DOI: 10.1136/bmjdrc-2019-001094] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 03/20/2020] [Accepted: 03/24/2020] [Indexed: 12/16/2022] Open
Abstract
US adults visit eye care providers more often than primary healthcare providers, placing these doctors in a prime position to help identify and manage patients with prediabetes and diabetes. Currently, diabetes is identified in eye clinics in an advanced stage, only after visible signs of diabetic retinopathy. Recent ophthalmic research has identified multiple subclinical and clinical changes that occur in the anterior segment of the eye with metabolic disease. The corneal epithelium exhibits increased defects and poor healing, including an increased risk of neurotrophic keratitis. Increased thickness and stiffness of the cornea artificially alters intraocular pressure. There is damage to the endothelial cells and changes to the bacterial species on the ocular surface, both of which can increase risk of complications with surgery. Decreased corneal sensitivity due to a loss of nerve density predispose patients with metabolic disease to further neurotrophic complications. Patients with diabetes have increased Meibomian gland dysfunction, blepharitis and reduced tear production, resulting in increased rates of dry eye disease and discomfort. Early detection of metabolic disease may allow eye care providers to be more proactive in recommending referral and intervention in order to reduce the risk of blindness and other diabetes-related morbidity. Continued research is needed to better understand the time course of changes to the anterior segment and what can be done to better detect and diagnose patients with prediabetes or undiagnosed diabetes and provide improved care for these patients.
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Affiliation(s)
- Kathryn Richdale
- College of Optometry, University of Houston, Houston, Texas, USA
| | - Cecilia Chao
- College of Optometry, University of Houston, Houston, Texas, USA
- School of Optometry and Vision Science, University of New South Wales-Kensington Campus, Sydney, New South Wales, Australia
| | - Marc Hamilton
- Health and Human Performance, University of Houston, Houston, Texas, USA
- Biology and Biochemistry, University of Houston, Houston, Texas, USA
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Ramm L, Herber R, Spoerl E, Pillunat LE, Terai N. Intraocular pressure measurements in diabetes mellitus. Eur J Ophthalmol 2019; 30:1432-1439. [PMID: 31779470 DOI: 10.1177/1120672119890517] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE To investigate the impact of diabetes mellitus-induced changes on intraocular pressure measurements using Goldmann applanation tonometry, Ocular Response Analyzer, and Corvis ST. METHODS Measurements were done using Goldmann applanation tonometry, Ocular Response Analyzer, and Corvis ST in 69 diabetic patients. Biomechanical-corrected intraocular pressure values by Ocular Response Analyzer (IOPcc) and Corvis ST (bIOP) were used. In addition, biometry and tomography were performed and information on diabetes mellitus specific factors was collected. Results were compared to an age-matched group of 68 healthy subjects. RESULTS In diabetes mellitus, Goldmann applanation tonometry intraocular pressure (P = 0.193) and central corneal thickness (P = 0.184) were slightly increased. Also, IOPcc (P = 0.075) and bIOP (P = 0.542) showed no significant group difference. In both groups, IOPcc was higher than Goldmann applanation tonometry intraocular pressure (P = 0.002, P < 0.001), while bIOP was nearly equal to Goldmann applanation tonometry intraocular pressure (P = 0.795, P = 0.323). Central corneal thickness showed a tendency to higher values in poorly controlled than in controlled diabetes mellitus (P = 0.059). Goldmann applanation tonometry intraocular pressure correlated to central corneal thickness, while IOPcc and bIOP were independent from central corneal thickness in both groups. All intraocular pressure values showed significant associations to corneal biomechanical parameters. Only in diabetes mellitus, bIOP was correlated to Pachy slope (P = 0.023). CONCLUSION In diabetes mellitus, Goldmann applanation tonometry intraocular pressure was slightly, but not significantly, increased, which might be caused by a higher central corneal thickness and changes in corneal biomechanical properties. However, intraocular pressure values measured by Ocular Response Analyzer and Corvis ST were not significantly different between diabetes mellitus patients and healthy subjects. The bIOP showed a higher agreement with Goldmann applanation tonometry than IOPcc and was independent from central corneal thickness.
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Affiliation(s)
- Lisa Ramm
- Department of Ophthalmology, University Hospital Carl Gustav Carus, TU Dresden, Germany
| | - Robert Herber
- Department of Ophthalmology, University Hospital Carl Gustav Carus, TU Dresden, Germany
| | - Eberhard Spoerl
- Department of Ophthalmology, University Hospital Carl Gustav Carus, TU Dresden, Germany
| | - Lutz E Pillunat
- Department of Ophthalmology, University Hospital Carl Gustav Carus, TU Dresden, Germany
| | - Naim Terai
- Department of Ophthalmology, University Hospital Carl Gustav Carus, TU Dresden, Germany
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Intraocular Pressure Measurement Using Ocular Response Analyzer, Dynamic Contour Tonometer, and Scheimpflug Analyzer Corvis ST. J Ophthalmol 2019; 2019:3879651. [PMID: 31737355 PMCID: PMC6815996 DOI: 10.1155/2019/3879651] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 09/17/2019] [Indexed: 11/29/2022] Open
Abstract
Purpose To compare intraocular pressure (IOP) measurements with Goldmann applanation tonometry (GAT), ocular response analyzer (ORA), dynamic contour tonometer (DCT), and Corvis ST (CST) in healthy subjects. Methods In a prospective, observational study, IOP measurements with GAT (GAT-IOPc), ORA (IOPcc), DCT (DCT-IOP), and CST (bIOP) were performed and analyzed in 94 healthy subjects. Results Mean age of the participants was 45.6 ± 17.2 years (range 18 to 81 years). Mean GAT-IOPc was 12.9 ± 2.4 mmHg, mean DCT-IOP was 16.1 ± 2.6 mmHg, and mean IOPcc was 15.6 ± 3.3 mmHg. DCT-IOP and IOPcc were significantly higher than GAT-IOPc (P < 0.001). Mean bIOP was 13.5 ± 2.4 mmHg that was slightly higher but not significantly different from GAT-IOPc (P=0.146). Correlation analysis of IOP values and central corneal thickness (CCT) revealed a negative correlation between GAT-IOPc and CCT (r = −0.347; P=0.001). However, IOPcc, DCT-IOP, and bIOP showed no significant correlation to CCT. Only bIOP revealed a weak but significant age dependency (r = 0.321, P=0.002). Conclusion All tonometry devices showed a good agreement of biomechanical corrected IOP values with GAT-IOPc. As no influence of CCT on IOPcc, DCT-IOP, and bIOP was detectable, the used correction algorithms appear to be appropriate in these tonometers in the clinical setting. The highest agreement was found between GAT-IOPc and bIOP. However, bIOP weakly correlated with participants' age. Further studies are needed to elucidate the role of bIOP for IOP measurement.
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McKay TB, Priyadarsini S, Karamichos D. Mechanisms of Collagen Crosslinking in Diabetes and Keratoconus. Cells 2019; 8:cells8101239. [PMID: 31614631 PMCID: PMC6830090 DOI: 10.3390/cells8101239] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 10/09/2019] [Accepted: 10/10/2019] [Indexed: 12/14/2022] Open
Abstract
Collagen crosslinking provides the mechanical strength required for physiological maintenance of the extracellular matrix in most tissues in the human body, including the cornea. Aging and diabetes mellitus (DM) are processes that are both associated with increased collagen crosslinking that leads to increased corneal rigidity. By contrast, keratoconus (KC) is a corneal thinning disease associated with decreased mechanical stiffness leading to ectasia of the central cornea. Studies have suggested that crosslinking mediated by reactive advanced glycation end products during DM may protect the cornea from KC development. Parallel to this hypothesis, riboflavin-mediated photoreactive corneal crosslinking has been proposed as a therapeutic option to halt the progression of corneal thinning by inducing intra- and intermolecular crosslink formation within the collagen fibrils of the stroma, leading to stabilization of the disease. Here, we review the pathobiology of DM and KC in the context of corneal structure, the epidemiology behind the inverse correlation of DM and KC development, and the chemical mechanisms of lysyl oxidase-mediated crosslinking, advanced glycation end product-mediated crosslinking, and photoreactive riboflavin-mediated corneal crosslinking. The goal of this review is to define the biological and chemical pathways important in physiological and pathological processes related to collagen crosslinking in DM and KC.
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Affiliation(s)
- Tina B McKay
- Schepens Eye Research Institute/Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA 02114, USA.
| | - Shrestha Priyadarsini
- Department of Ophthalmology/Dean McGee Eye Institute, University of Oklahoma Health Science Center, Oklahoma City, OK 73104, USA.
| | - Dimitrios Karamichos
- Department of Ophthalmology/Dean McGee Eye Institute, University of Oklahoma Health Science Center, Oklahoma City, OK 73104, USA.
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Laville V, Kang JH, Cousins CC, Iglesias AI, Nagy R, Cooke Bailey JN, Igo RP, Song YE, Chasman DI, Christen WG, Kraft P, Rosner BA, Hu F, Wilson JF, Gharahkhani P, Hewitt AW, Mackey DA, Hysi PG, Hammond CJ, vanDuijn CM, Haines JL, Vitart V, Fingert JH, Hauser MA, Aschard H, Wiggs JL, Khawaja AP, MacGregor S, Pasquale LR. Genetic Correlations Between Diabetes and Glaucoma: An Analysis of Continuous and Dichotomous Phenotypes. Am J Ophthalmol 2019; 206:245-255. [PMID: 31121135 PMCID: PMC6864262 DOI: 10.1016/j.ajo.2019.05.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Revised: 05/03/2019] [Accepted: 05/09/2019] [Indexed: 01/05/2023]
Abstract
PURPOSE A genetic correlation is the proportion of phenotypic variance between traits that is shared on a genetic basis. Here we explore genetic correlations between diabetes- and glaucoma-related traits. DESIGN Cross-sectional study. METHODS We assembled genome-wide association study summary statistics from European-derived participants regarding diabetes-related traits like fasting blood sugar (FBS) and type 2 diabetes (T2D) and glaucoma-related traits (intraocular pressure [IOP], central corneal thickness [CCT], corneal hysteresis [CH], corneal resistance factor [CRF], cup-to-disc ratio [CDR], and primary open-angle glaucoma [POAG]). We included data from the National Eye Institute Glaucoma Human Genetics Collaboration Heritable Overall Operational Database, the UK Biobank, and the International Glaucoma Genetics Consortium. We calculated genetic correlation (rg) between traits using linkage disequilibrium score regression. We also calculated genetic correlations between IOP, CCT, and select diabetes-related traits based on individual level phenotype data in 2 Northern European population-based samples using pedigree information and Sequential Oligogenic Linkage Analysis Routines. RESULTS Overall, there was little rg between diabetes- and glaucoma-related traits. Specifically, we found a nonsignificant negative correlation between T2D and POAG (rg = -0.14; P = .16). Using Sequential Oligogenic Linkage Analysis Routines, the genetic correlations between measured IOP, CCT, FBS, fasting insulin, and hemoglobin A1c were null. In contrast, genetic correlations between IOP and POAG (rg ≥ 0.45; P ≤ 3.0 × 10-4) and between CDR and POAG were high (rg = 0.57; P = 2.8 × 10-10). However, genetic correlations between corneal properties (CCT, CRF, and CH) and POAG were low (rg range -0.18 to 0.11) and nonsignificant (P ≥ .07). CONCLUSION These analyses suggest that there is limited genetic correlation between diabetes- and glaucoma-related traits.
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Affiliation(s)
- Vincent Laville
- Department of Computational Biology, Institut Pasteur, Paris, France
| | - Jae H Kang
- Channing Division of Network Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Clara C Cousins
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Adriana I Iglesias
- Departments of Ophthalmology and Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Réka Nagy
- MRC Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Jessica N Cooke Bailey
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA; Institute for Computational Biology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Robert P Igo
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Yeunjoo E Song
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA; Institute for Computational Biology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Daniel I Chasman
- Division of Preventive Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - William G Christen
- Division of Preventive Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Peter Kraft
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Harvard Medical School, Boston, Massachusetts, USA; Department of Biostatistics, Harvard T. H. Chan School of Public Health, Harvard Medical School, Boston, Massachusetts, USA
| | - Bernard A Rosner
- Channing Division of Network Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Biostatistics, Harvard T. H. Chan School of Public Health, Harvard Medical School, Boston, Massachusetts, USA
| | - Frank Hu
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Harvard Medical School, Boston, Massachusetts, USA; Department of Nutrition, Harvard T. H. Chan School of Public Health, Harvard Medical School, Boston, Massachusetts, USA
| | - James F Wilson
- MRC Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom; Centre for Global Health Research, Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - Puya Gharahkhani
- Statistical Genetics, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Alex W Hewitt
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia; School of Medicine, Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - David A Mackey
- Lions Eye Institute, Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, Western Australia, Australia
| | - Pirro G Hysi
- Department of Twin Research and Genetic Epidemiology, King's College London, United Kingdom
| | - Christopher J Hammond
- Department of Twin Research and Genetic Epidemiology, King's College London, United Kingdom
| | - Cornelia M vanDuijn
- Departments of Ophthalmology and Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands; Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Jonathan L Haines
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA; Institute for Computational Biology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Veronique Vitart
- MRC Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - John H Fingert
- Department of Ophthalmology and Visual Science, University of Iowa, Iowa City, Iowa, USA
| | - Michael A Hauser
- Departments of Ophthalmology and Medicine, Duke University, Durham, North Carolina, USA
| | - Hugues Aschard
- Department of Computational Biology, Institut Pasteur, Paris, France; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Harvard Medical School, Boston, Massachusetts, USA
| | - Janey L Wiggs
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Anthony P Khawaja
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Stuart MacGregor
- Statistical Genetics, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Louis R Pasquale
- Channing Division of Network Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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Consejo A, Glawdecka K, Karnowski K, Solarski J, Rozema JJ, Wojtkowski M, Iskander DR. Corneal Properties of Keratoconus Based on Scheimpflug Light Intensity Distribution. ACTA ACUST UNITED AC 2019; 60:3197-3203. [DOI: 10.1167/iovs.19-26963] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Alejandra Consejo
- Institute of Physical Chemistry, Polish Academy of Sciences, Warsaw, Poland
| | - Karolina Glawdecka
- Department of Biomedical Engineering, Wroclaw University of Science and Technology, Wroclaw, Poland
| | - Karol Karnowski
- Institute of Physical Chemistry, Polish Academy of Sciences, Warsaw, Poland
- School of Electrical, Electronic and Computer Engineering, The University of Western Australia, Perth, Australia
| | - Jedrzej Solarski
- Institute of Physical Chemistry, Polish Academy of Sciences, Warsaw, Poland
| | - Jos J. Rozema
- Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium
- Department of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Maciej Wojtkowski
- Institute of Physical Chemistry, Polish Academy of Sciences, Warsaw, Poland
| | - D. Robert Iskander
- Department of Biomedical Engineering, Wroclaw University of Science and Technology, Wroclaw, Poland
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Zhang B, Shweikh Y, Khawaja AP, Gallacher J, Bauermeister S, Foster PJ. Associations with Corneal Hysteresis in a Population Cohort: Results from 96 010 UK Biobank Participants. Ophthalmology 2019; 126:1500-1510. [PMID: 31471087 DOI: 10.1016/j.ophtha.2019.06.029] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 06/07/2019] [Accepted: 06/28/2019] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To describe the distribution of corneal hysteresis (CH) in a large cohort and explore its associated factors and possible clinical applications. DESIGN Cross-sectional study within the UK Biobank, a large cohort study in the United Kingdom. PARTICIPANTS We analyzed CH data from 93 345 eligible participants in the UK Biobank cohort, aged 40 to 69 years. METHODS All analyses were performed using left eye data. Linear regression models were used to evaluate associations between CH and demographic, lifestyle, ocular, and systemic variables. Piecewise logistic regression models were used to explore the relationship between self-reported glaucoma and CH. MAIN OUTCOME MEASURES Corneal hysteresis (mmHg). RESULTS The mean CH was 10.6 mmHg (10.4 mmHg in male and 10.8 mmHg in female participants). After adjusting for covariables, CH was significantly negatively associated with male sex, age, black ethnicity, self-reported glaucoma, diastolic blood pressure, and height. Corneal hysteresis was significantly positively associated with smoking, hyperopia, diabetes, systemic lupus erythematosus (SLE), greater deprivation (Townsend index), and Goldmann-correlated intraocular pressure (IOPg). Self-reported glaucoma and CH were significantly associated when CH was less than 10.1 mmHg (odds ratio, 0.86; 95% confidence interval, 0.79-0.94 per mmHg CH increase) after adjusting for covariables. When CH exceeded 10.1 mmHg, there was no significant association between CH and self-reported glaucoma. CONCLUSIONS In our analyses, CH was significantly associated with factors including age, sex, and ethnicity, which should be taken into account when interpreting CH values. In our cohort, lower CH was significantly associated with a higher prevalence of self-reported glaucoma when CH was less than 10.1 mmHg. Corneal hysteresis may serve as a biomarker aiding glaucoma case detection.
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Affiliation(s)
- Bing Zhang
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Yusrah Shweikh
- National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom; UCL Institute of Ophthalmology, London, United Kingdom
| | - Anthony P Khawaja
- National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom; UCL Institute of Ophthalmology, London, United Kingdom
| | - John Gallacher
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | | | - Paul J Foster
- National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom; UCL Institute of Ophthalmology, London, United Kingdom.
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An Update on Corneal Biomechanics and Architecture in Diabetes. J Ophthalmol 2019; 2019:7645352. [PMID: 31275634 PMCID: PMC6589322 DOI: 10.1155/2019/7645352] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 05/02/2019] [Indexed: 12/12/2022] Open
Abstract
In the last decade, we have witnessed substantial progress in our understanding of corneal biomechanics and architecture. It is well known that diabetes is a systemic metabolic disease that causes chronic progressive damage in the main organs of the human body, including the eyeball. Although the main and most widely recognized ocular effect of diabetes is on the retina, the structure of the cornea (the outermost and transparent tissue of the eye) can also be affected by the poor glycemic control characterizing diabetes. The different corneal structures (epithelium, stroma, and endothelium) are affected by specific complications of diabetes. The development of new noninvasive diagnostic technologies has provided a better understanding of corneal tissue modifications. The objective of this review is to describe the advances in the knowledge of the corneal alterations that diabetes can induce.
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Structural and Biomechanical Corneal Differences between Type 2 Diabetic and Nondiabetic Patients. J Ophthalmol 2019; 2019:3764878. [PMID: 31011451 PMCID: PMC6442329 DOI: 10.1155/2019/3764878] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 02/19/2019] [Accepted: 02/27/2019] [Indexed: 11/18/2022] Open
Abstract
Purpose To analyze and compare corneal structural and biomechanical properties, characterized by corneal hysteresis (CH) and resistance factor (CRF), between patients with and without type 2 diabetes mellitus (DM), and determine the main ocular variables that influence them. Methods Sixty diabetic and 48 age- and sex-matched non-DM patients were enrolled in this cross-sectional study. The DM group was analyzed according to DM duration (<or ≥ 10 years), HbA1c levels (<or ≥ 7%), and presence of retinopathy. CH and CRF were evaluated using the Ocular Response Analyzer® (ORA). Central corneal thickness (CCT) was determined by Scheimpflug tomography (Pentacam® HR). Intraocular pressure was obtained with ORA (IOPcc) and Goldmann applanation tonometry (IOP-GAT). Univariate and multivariate linear regression analyses were performed to evaluate the relationship between demographical, clinical, and ocular variables with the biomechanical properties. Results There were no statistically significant differences in the CH and the CRF between DM and non-DM groups (p=0.637 and p=0.439, respectively). Also, there was no statistical difference between groups for the CCT, IOPcc, or IOP-GAT. Multivariate linear regression analysis showed that CH was positively associated with CCT (p < 0.001) and negatively associated with IOPcc (p < 0.001), while CRF was positively associated with CCT (p < 0.001) and IOPcc (p=0.014). Conclusion The CCT and IOPcc were found to be the main parameters that affect corneal biomechanical properties both in diabetics and controls. In this study, there was no significant effect of DM type 2 on corneal biomechanics.
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Scheimpflug Camera and Swept-Source Optical Coherence Tomography in Pachymetry Evaluation of Diabetic Patients. J Ophthalmol 2019; 2019:4532657. [PMID: 31143471 PMCID: PMC6501162 DOI: 10.1155/2019/4532657] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 02/27/2019] [Accepted: 03/12/2019] [Indexed: 02/07/2023] Open
Abstract
Aim The comparative analysis of the central and peripheral corneal thicknesses using two different imaging systems: Scheimpflug camera and swept-source OCT was performed to investigate the differences in corneal thickness analysis in diabetic patients. Materials and Methods The study group consisted of the 147 eyes of 107 diabetic patients who were examined and compared with 138 eyes of 89 nondiabetic cataract patients. The inclusion criteria for the study group was diabetes mellitus type II identified no less than 10 years ago, with NPDR not requiring prior laser treatment. The control group was recruited from nondiabetic patients. Measurements were obtained on the Pentacam Scheimpflug imaging system and Casia swept-source OCT. All study parameters from anterior chamber images were processed for five different zones, the central zone and four peripherals—superior, inferior, nasal, and temporal. A fit zone diameter of 4 mm was applied for both instruments. Results The Pentacam system overestimated corneal measurements in the DM group when compared with the Casia OCT in superior corneal zone (p=0.04), inferior corneal zone (p=0.02), nasal corneal zone (p < 0.001), and temporal corneal zone (p=0.01). In the control group, there were also statistically significant differences between the Pentacam and Casia OCT measured values in inferior corneal zone (p=0.001), nasal corneal zone (p=0.04), and temporal corneal zone (p < 0.001). Conclusion Scheimpflug camera pachymetry measurements showed statistically higher CCT values when compared with swept-source OCT measurements.
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Blackburn BJ, Jenkins MW, Rollins AM, Dupps WJ. A Review of Structural and Biomechanical Changes in the Cornea in Aging, Disease, and Photochemical Crosslinking. Front Bioeng Biotechnol 2019; 7:66. [PMID: 31019909 PMCID: PMC6459081 DOI: 10.3389/fbioe.2019.00066] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 03/07/2019] [Indexed: 12/27/2022] Open
Abstract
The study of corneal biomechanics is motivated by the tight relationship between biomechanical properties and visual function within the ocular system. For instance, variation in collagen fibril alignment and non-enzymatic crosslinks rank high among structural factors which give rise to the cornea's particular shape and ability to properly focus light. Gradation in these and other factors engender biomechanical changes which can be quantified by a wide variety of techniques. This review summarizes what is known about both the changes in corneal structure and associated changes in corneal biomechanical properties in aging, keratoconic, and photochemically crosslinked corneas. In addition, methods for measuring corneal biomechanics are discussed and the topics are related to both clinical studies and biomechanical modeling simulations.
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Affiliation(s)
- Brecken J. Blackburn
- Cole Eye Institute, Cleveland Clinic, Cleveland, OH, United States
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
- Department of Ophthalmology, Cleveland Clinic Lerner College of Medicine of CWRU, Cleveland, OH, United States
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States
| | - Michael W. Jenkins
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States
- Department of Pediatrics, Case Western Reserve University, Cleveland, OH, United States
| | - Andrew M. Rollins
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States
| | - William J. Dupps
- Cole Eye Institute, Cleveland Clinic, Cleveland, OH, United States
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States
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Measurement of Corneal Biomechanical Properties in Diabetes Mellitus Using the Ocular Response Analyzer and the Corvis ST. Cornea 2019; 38:595-599. [DOI: 10.1097/ico.0000000000001879] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Kumar N, Pop-Busui R, Musch DC, Reed DM, Momont AC, Hussain M, Raval N, Moroi SE, Shtein R. Central Corneal Thickness Increase Due to Stromal Thickening With Diabetic Peripheral Neuropathy Severity. Cornea 2018; 37:1138-1142. [PMID: 29923859 PMCID: PMC6081252 DOI: 10.1097/ico.0000000000001668] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE To investigate the relationship between central corneal thickness (CCT) and diabetes disease severity among patients with diabetic peripheral neuropathy (DPN) compared with controls. METHODS In this cross-sectional study, 34 participants were examined. DPN status was assessed by clinical examination, nerve conduction studies, and quantitative sensory testing. All participants underwent comprehensive eye examination that included intraocular pressure measured by Goldmann applanation tonometry. CCT was measured by ultrasound pachymetry, and the thickness of corneal layers was assessed by corneal confocal microscopy. Association of CCT and DPN was examined using ANOVA. RESULTS Among the 34 participants, there were 9 controls, 16 patients with mild DPN, and 9 patients with severe DPN. CCT was significantly increased in the DPN groups compared with controls (P = 0.0003). Mean CCT among controls was 552.7 ± 29.2 μm compared with 583.4 ± 25.0 μm in the mild DPN group and 613.3 ± 28.8 μm in the severe DPN group. In addition, stromal thickness differed significantly between the 3 study groups (P = 0.045). Mean stromal thickness among controls was 439.5 ± 23.5 μm compared with 478.9 ± 37.5 μm in the mild DPN group and 494.5 ± 39.1 μm in the severe DPN group. CONCLUSIONS This study demonstrates that CCT increases with DPN severity because of an increase in stromal thickness. CCT increase associated with DPN has important clinical implications including glaucoma progression, keratoconus susceptibility, and intraocular pressure assessment and should be accounted for when evaluating patients with diabetes.
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Affiliation(s)
- Navasuja Kumar
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, 1000 Wall Street, Ann Arbor, MI 48105, USA
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA
| | - Rodica Pop-Busui
- Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, University of Michigan Medical School, Ann Arbor, MI 48109 USA
| | - David C. Musch
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, 1000 Wall Street, Ann Arbor, MI 48105, USA
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA
| | - David M. Reed
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, 1000 Wall Street, Ann Arbor, MI 48105, USA
| | - Anna C. Momont
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, 1000 Wall Street, Ann Arbor, MI 48105, USA
- Currently at Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, University Station Clinic, Madison, WI 53705, USA
| | - Munira Hussain
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, 1000 Wall Street, Ann Arbor, MI 48105, USA
| | - Nilesh Raval
- Wayne State University School of Medicine, Wayne State University School of Medicine, Detroit, MI 48201, USA
| | - Sayoko E. Moroi
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, 1000 Wall Street, Ann Arbor, MI 48105, USA
| | - Roni Shtein
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, 1000 Wall Street, Ann Arbor, MI 48105, USA
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Systemic Disease and Long-term Intraocular Pressure Mean, Peak, and Variability in Nonglaucomatous Eyes. Am J Ophthalmol 2018; 193:184-196. [PMID: 29981739 DOI: 10.1016/j.ajo.2018.06.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 06/26/2018] [Accepted: 06/28/2018] [Indexed: 12/25/2022]
Abstract
PURPOSE Elevated intraocular pressure (IOP) is a well-known risk factor in glaucoma development and progression. As most glaucoma risk factors are not modifiable, IOP remains the sole focus of medical and surgical therapy. Identifying modifiable factors and their effects on IOP, such as systemic diseases, is therefore of interest. The objective is to assess the long-term, longitudinal relationship between systemic diseases and IOP mean, peak, and variability, including diabetes, hypertension, body mass index (BMI), and smoking status. DESIGN Secondary analysis of randomized clinical trial data. METHODS Longitudinal IOP and systemic disease data from the Age-Related Eye Disease Study (AREDS), a randomized clinical trial of high-dose antioxidants, was analyzed. STUDY POPULATION A total of 3909 older participants without a reported diagnosis of glaucoma or glaucoma treatment during AREDS with up to 12 years of annual IOP and systemic disease data. MAIN OUTCOME MEASURES Independent systemic disease risk factors associated with IOP. RESULTS Univariate analysis identified numerous systemic disease factors associated with IOP mean, peak, and variability. Longitudinal adjusted models identified diabetes, obesity, and systolic hypertension as significantly associated with increased IOP, while systemic beta-blocker use was inversely associated. CONCLUSIONS Results demonstrate a relationship between multiple systemic diseases and IOP; moreover, they demonstrate that systemic diseases influence additional parameters beyond mean IOP, such as IOP peak and variability. Although only to be taken within the context of IOP, these population-level trends reveal potentially modifiable factors in IOP control, and are particularly important in the context of increasing obesity and diabetes prevalence rates in American adults.
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Bekmez S, Kocaturk T. Higher Intraocular Pressure Levels Associated With Lower Hysteresis In Type 2 Diabetes. Open Ophthalmol J 2018; 12:29-33. [PMID: 29643950 PMCID: PMC5876923 DOI: 10.2174/1874364101812010029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 02/10/2018] [Accepted: 03/07/2018] [Indexed: 11/25/2022] Open
Abstract
Aim: To investigate the differences of corneal biomechanic characteristics using Ocular Response Analyzer (ORA, Reichert; USA) on type 2 diabetics and healthy subjects. Methods: One hundred eyes of 100 subjects (between the ages of 17-91) who applied to Adnan Menderes University’s Ophthalmology Clinic between January-March 2015 were included in this study, 50 diabetics (Group 1) and 50 healthy controls (Group 2). The eyes included in the study were randomly chosen. Corneal Hysteresis (CH), Corneal Resistance Factor (CRF), Goldmann correlated Intraocular Pressure (IOPg) and corneal compensated Intraocular Pressure (IOPcc) of patients were measured by ORA. Detailed ophthalmological examinations were done for every subject. Kolmogorov-Smirnov test was used to analyze the distribution of quantitative variables and t test was used for the data that were normally distributed. Any p value <0.05 was considered as statistically significant. Results: The mean ages were 63.3±9.0 and 61.7±11.6 in Group 1 and 2, respectively (p=0.459). 25 (50.0%) were female, 25 (50.0%) were male in Group 1 and 26 (52.0%) were female, 24 (48.0%) were male in Group 2 (p=1.000). Mean IOPcc values were 17.8±3.6 (12.1-29.0) and 16.0±3.1 (10.9-23.8) mmHg (p=0.006); mean IOPg values were 16.9±3.5 (10.9-25.9) and 15.4±2.9 (9.0-24.7) mmHg (p=0.032); mean CH values were 9.9±1.5 (6.1-13.3) and 10.5±1.7 (6.5-15.7) (p=0.080) and mean CRF values were 10.4±1.6 (7.5-14.0) and 10.5±1.7 (6.6-15.4) (p=0.730) in Groups 1 and 2, respectively. Conclusions: There was no any statistical difference between the groups in terms of CH and CRF. However, mean CH and CRF values were found less in diabetic group. Corneal biomechanical differences seen in diabetic patients may be associated with a statistically significantly higher IOP measurements.
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Affiliation(s)
- Sinan Bekmez
- Department of Ophthalmology, Dr. Behcet Uz Children's Training and Research Hospital, Izmir, Turkey
| | - Tolga Kocaturk
- Department of Ophthalmology, Faculty of Medicine, Adnan Menderes University, Aydin, Turkey
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Santiagu F, Bakhtiari A, Iqbal T, Khaliddin N, Lansingh VC, Subrayan V. Diabetes and pachymetry changes in pregnancy. Int Ophthalmol 2017; 38:2069-2076. [PMID: 28879527 DOI: 10.1007/s10792-017-0701-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 08/23/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Purpose of this study is to evaluate changes in the central corneal thickness (CCT) in patients during the third trimester and postpartum phases of normal pregnancy, pregestational diabetes mellitus (DM), and gestational diabetes mellitus (GDM). METHODS This was a prospective study. Patients that fulfilled the inclusion criteria were recruited from the obstetric clinic. They were grouped into normal pregnancy, pregestational DM, and GDM. Ophthalmic assessment and haematological investigations were done during the third trimester (after 28 weeks of gestation) and in the postpartum phase (6 weeks postpartum). RESULTS A total of 192 pregnant patients were recruited for this study. Out of the 192 patients, only 143 of them came back for their follow-up 6 weeks postpartum. A total of 70 (36.5%) normal pregnancy patients, 51 (26.6%) DM patients, and 71 (36.9%) GDM patients were included in this prospective study. Our study showed that the CCT decreased postpartum in all three groups. Patients in all three groups did not have significantly different CCT during the third trimester of pregnancy and postpartum phase. However, patients who had thicker CCT irrespective of the grouping during the third trimester also had a thicker CCT post-delivery (p value <0.001). However, these changes did not appear to affect refractive error and visual acuity. CONCLUSIONS Diabetes mellitus during pregnancy did not appear to influence the CCT.
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Affiliation(s)
- Florence Santiagu
- University Malaya Medical Center, Lembah Pantai, 59100, Kuala Lumpur, Malaysia. .,Shah Alam Hospital, Persiaran Kayangan, Seksyen 7, 40000, Shah Alam, Selangor, Malaysia.
| | - Azam Bakhtiari
- University Malaya Medical Center, Lembah Pantai, 59100, Kuala Lumpur, Malaysia
| | - Tajunisah Iqbal
- University Malaya Medical Center, Lembah Pantai, 59100, Kuala Lumpur, Malaysia
| | - Nurliza Khaliddin
- University Malaya Medical Center, Lembah Pantai, 59100, Kuala Lumpur, Malaysia
| | - Van C Lansingh
- University of Miami, 1320 S Dixie Hwy, Coral Gables, FL, 33146, USA
| | - Visvaraja Subrayan
- University Malaya Medical Center, Lembah Pantai, 59100, Kuala Lumpur, Malaysia
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Akil H, Buluş AD, Andiran N, Alp MN. Ocular manifestations of Type 1 diabetes mellitus in pediatric population. Indian J Ophthalmol 2017; 64:654-658. [PMID: 27853013 PMCID: PMC5151155 DOI: 10.4103/0301-4738.194336] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Context: To evaluate the necessity of ocular screening in Type 1 diabetes mellitus (DM). Aims: This study aims to investigate the diabetes-related ocular changes according to the glycosylated hemoglobin (HbA1c) level and duration of diabetes in children and compare the results with nondiabetic healthy children. Settings and Design: Observational cross-sectional study designed by ophthalmology and pediatric endocrinology clinics. Subjects and Methods: Forty-two children with Type 1 DM, 42 healthy gender- and age-matched children as controls were enrolled. All patients underwent ophthalmic and physical examination, with a review of medical history and current medication. HbA1c level, best corrected visual acuity, intraocular pressure (IOP), central corneal thickness (CCT), tear break-up time (BUT), Schirmer test, dilated fundus examination findings, central retinal thickness (CRT), and total macular volume (TMV) measurements were noted. Statistical Analysis: Descriptive statistics, Student's t-test, Mann–Whitney U-test, Chi-square test for comparison of the group parameters and correlation analyses (Spearman analysis) were performed with SPSS statistical software 17.0 (SPSS Inc., Chicago, IL, USA). Results: Type 1 DM group exhibited significantly reduced Schirmer test, increased IOP and decreased retinal thickness relative to the age-matched control group (P < 0.05) but no statistically significant difference was found for the BUT (P = 0.182) and for the CCT (P = 0.495). The correlations between the age, duration, HbA1c and IOP, BUT, Schirmer test, TMV, CRT measurements did not reach statistical significance. Conclusions: More frequent screening may be needed for complications, including neuropathy-related dry eye syndrome, IOP changes, and diabetic retinopathy in children with Type 1 DM.
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Affiliation(s)
- Handan Akil
- Department of Ophthalmology, Doheny Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Ayse Derya Buluş
- Department of Pediatric Endocrinology Clinic, Kecioren Training and Research Hospital, Ankara, Turkey
| | - Nesibe Andiran
- Department of Pediatric Endocrinology Clinic, Kecioren Training and Research Hospital, Ankara, Turkey
| | - Mehmet Numan Alp
- Department of Ophthalmology, Numune Education and Research Hospital, Ankara, Turkey
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Bao F, Deng M, Zheng X, Li L, Zhao Y, Cao S, Yu AY, Wang Q, Huang J, Elsheikh A. Effects of diabetes mellitus on biomechanical properties of the rabbit cornea. Exp Eye Res 2017; 161:82-88. [PMID: 28603017 DOI: 10.1016/j.exer.2017.05.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 05/14/2017] [Accepted: 05/30/2017] [Indexed: 01/13/2023]
Abstract
To investigate the effects of diabetes on the biomechanical behavior of cornea in alloxan-induced diabetic rabbits. Diabetes mellitus (DM) was induced in 20 rabbits using alloxan, while another 20 age- and weight-matched non-diabetic rabbits served as controls. Eyes were enucleated after 8 weeks of inducing diabetes and the whole cornea was removed with a 3 mm wide scleral ring and tested under inflation conditions with an internal pressure range of 2.0-30.0 mmHg to determine their stress-strain behavior using an inverse analysis process. The blood glucose level (BG), advanced glycosylation end products (AGEs), central corneal thickness (CCT) and intraocular pressure (IOP) increased significantly in the DM group. There were statistically significant correlations between BG and AGEs (r = 0.768, p = 0.00), and between AGEs and CCT variation upon induction of DM (r = 0.594, p = 0.00). The tangent modulus (Et) of the cornea at four stress levels (1-4 kPa, equivalent to approximately IOP of 7.5, 15, 22.5 and 30 mmHg, respectively) was significantly higher in diabetic rabbits than in the control group (p < 0.05). Further, Et at stress of 2 kPa (which corresponded to the average IOP for the control group) was significantly correlated with BG (r = 0.378, p < 0.05), AGEs (r = 0.496, p < 0.05) and CCT variation upon induction of DM (r = 0.439, p < 0.05). IOP, as measured by contact tonometry, was also significantly correlated with both CCT (r = 0.315, p < 0.05) and Et at 2 kPa (r = 0.329, p < 0.05), and even after correcting for the effects of CCT and Et, IOP still significantly increased with both AGEs (r = 0.772, p = 0.00) and BG (r = 0.762, p = 0.00). The cornea of diabetic rabbits showed a significant increase in mechanical stiffness as evidenced by increases in corneal thickness and tangent modulus. The Et increase may be explained by a non-enzymatic cross-linking of collagen fibrils mediated by AGEs due to the high blood glucose levels in diabetes. The study also found significant IOP increases with higher blood glucose level even after controlling the effects of both corneal thickness and tangent modulus.
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Affiliation(s)
- FangJun Bao
- The Affiliated Eye Hospital of WenZhou Medical University, Wenzhou 325027, China; The Institution of Ocular Biomechanics, Wenzhou Medical University, Wenzhou, Zhejiang Province 325027, China
| | - ManLi Deng
- The Affiliated Eye Hospital of WenZhou Medical University, Wenzhou 325027, China
| | - XiaoBo Zheng
- The Affiliated Eye Hospital of WenZhou Medical University, Wenzhou 325027, China; The Institution of Ocular Biomechanics, Wenzhou Medical University, Wenzhou, Zhejiang Province 325027, China
| | - LinNa Li
- The Affiliated Eye Hospital of WenZhou Medical University, Wenzhou 325027, China; The Institution of Ocular Biomechanics, Wenzhou Medical University, Wenzhou, Zhejiang Province 325027, China
| | - YiPing Zhao
- The Affiliated Eye Hospital of WenZhou Medical University, Wenzhou 325027, China; The Institution of Ocular Biomechanics, Wenzhou Medical University, Wenzhou, Zhejiang Province 325027, China
| | - Si Cao
- The Affiliated Eye Hospital of WenZhou Medical University, Wenzhou 325027, China; The Institution of Ocular Biomechanics, Wenzhou Medical University, Wenzhou, Zhejiang Province 325027, China
| | - AYong Yu
- The Affiliated Eye Hospital of WenZhou Medical University, Wenzhou 325027, China
| | - QinMei Wang
- The Affiliated Eye Hospital of WenZhou Medical University, Wenzhou 325027, China; The Institution of Ocular Biomechanics, Wenzhou Medical University, Wenzhou, Zhejiang Province 325027, China.
| | - JinHai Huang
- The Affiliated Eye Hospital of WenZhou Medical University, Wenzhou 325027, China.
| | - Ahmed Elsheikh
- School of Engineering, University of Liverpool, Liverpool L69 3GH, UK; National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, UK
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Jesus DA, Majewska M, Krzyżanowska-Berkowska P, Iskander DR. Influence of eye biometrics and corneal micro-structure on noncontact tonometry. PLoS One 2017; 12:e0177180. [PMID: 28472178 PMCID: PMC5417684 DOI: 10.1371/journal.pone.0177180] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 04/23/2017] [Indexed: 02/07/2023] Open
Abstract
Purpose Tonometry is widely used as the main screening tool supporting glaucoma diagnosis. Still, its accuracy could be improved if full knowledge about the variation of the corneal biomechanical properties was available. In this study, Optical Coherence Tomography (OCT) speckle statistics are used to infer the organisation of the corneal micro-structure and hence, to analyse its influence on intraocular pressure (IOP) measurements. Methods Fifty-six subjects were recruited for this prospective study. Macro and micro-structural corneal parameters as well as subject age were considered. Macro-structural analysis included the parameters that are associated with the ocular anatomy, such as central corneal thickness (CCT), corneal radius, axial length, anterior chamber depth and white-to-white corneal diameter. Micro-structural parameters which included OCT speckle statistics were related to the internal organisation of the corneal tissue and its physiological changes during lifetime. The corneal speckle obtained from OCT was modelled with the Generalised Gamma (GG) distribution that is characterised with a scale parameter and two shape parameters. Results In macro-structure analysis, only CCT showed a statistically significant correlation with IOP (R2 = 0.25, p<0.001). The scale parameter and the ratio of the shape parameters of GG distribution showed statistically significant correlation with IOP (R2 = 0.19, p<0.001 and R2 = 0.17, p<0.001, respectively). For the studied group, a weak, although significant correlation was found between age and IOP (R2 = 0.053, p = 0.04). Forward stepwise regression showed that CCT and the scale parameter of the Generalised Gamma distribution can be combined in a regression model (R2 = 0.39, p<0.001) to study the role of the corneal structure on IOP. Conclusions We show, for the first time, that corneal micro-structure influences the IOP measurements obtained from noncontact tonometry. OCT speckle statistics can be employed to learn about the corneal micro-structure and hence, to further calibrate the IOP measurements.
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Affiliation(s)
- Danilo A. Jesus
- Department of Biomedical Engineering, Wroclaw University of Science & Technology, Wroclaw, Poland
- * E-mail:
| | - Małgorzata Majewska
- Department of Biomedical Engineering, Wroclaw University of Science & Technology, Wroclaw, Poland
| | | | - D. Robert Iskander
- Department of Biomedical Engineering, Wroclaw University of Science & Technology, Wroclaw, Poland
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Diabetic complications in the cornea. Vision Res 2017; 139:138-152. [PMID: 28404521 DOI: 10.1016/j.visres.2017.03.002] [Citation(s) in RCA: 148] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 03/31/2017] [Accepted: 03/31/2017] [Indexed: 12/15/2022]
Abstract
Diabetic corneal alterations, such as delayed epithelial wound healing, edema, recurrent erosions, neuropathy/loss of sensitivity, and tear film changes are frequent but underdiagnosed complications of both type 1 (insulin-dependent) and type 2 (non-insulin-dependent) diabetes mellitus. The disease affects corneal epithelium, corneal nerves, tear film, and to a lesser extent, endothelium, and also conjunctiva. These abnormalities may appear or become exacerbated following trauma, as well as various surgeries including retinal, cataract or refractive. The focus of the review is on mechanisms of diabetic corneal abnormalities, available animal, tissue and organ culture models, and emerging treatments. Changes of basement membrane structure and wound healing rates, the role of various proteinases, advanced glycation end products (AGEs), abnormal growth and motility factors (including opioid, epidermal, and hepatocyte growth factors) are analyzed. Experimental therapeutics under development, including topical naltrexone, insulin, inhibitors of aldose reductase, and AGEs, as well as emerging gene and cell therapies are discussed in detail.
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41
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A systematic review on the impact of diabetes mellitus on the ocular surface. Nutr Diabetes 2017; 7:e251. [PMID: 28319106 PMCID: PMC5380897 DOI: 10.1038/nutd.2017.4] [Citation(s) in RCA: 107] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 11/10/2016] [Accepted: 11/14/2016] [Indexed: 12/27/2022] Open
Abstract
Diabetes mellitus is associated with extensive morbidity and mortality in any human community. It is well understood that the burden of diabetes is attributed to chronic progressive damage in major end-organs, but it is underappreciated that the most superficial and transparent organ affected by diabetes is the cornea. Different corneal components (epithelium, nerves, immune cells and endothelium) underpin specific systemic complications of diabetes. Just as diabetic retinopathy is a marker of more generalized microvascular disease, corneal nerve changes can predict peripheral and autonomic neuropathy, providing a window of opportunity for early treatment. In addition, alterations of immune cells in corneas suggest an inflammatory component in diabetic complications. Furthermore, impaired corneal epithelial wound healing may also imply more widespread disease. The non-invasiveness and improvement in imaging technology facilitates the emergence of new screening tools. Systemic control of diabetes can improve ocular surface health, possibly aided by anti-inflammatory and vasoprotective agents.
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Koç M, Yavrum F, Uzel MM, Aydemir E, Özülken K, Yılmazbaş P. The Effect of Pterygium and Pterygium Surgery on Corneal Biomechanics. Semin Ophthalmol 2017; 33:449-453. [DOI: 10.1080/08820538.2017.1297839] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Mustafa Koç
- Ophthalmology Department, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | - Fuat Yavrum
- Ophthalmology Department, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | - Mehmet Murat Uzel
- Ophthalmology Department, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | - Emre Aydemir
- Ophthalmology Department, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | - Kemal Özülken
- Ophthalmology Department, Dünyagöz Hospital, Ankara, Turkey
| | - Pelin Yılmazbaş
- Ophthalmology Department, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
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Tejwani S, Dinakaran S, Joshi A, Shetty R, Sinha Roy A. A cross-sectional study to compare intraocular pressure measurement by sequential use of Goldman applanation tonometry, dynamic contour tonometry, ocular response analyzer, and Corvis ST. Indian J Ophthalmol 2016; 63:815-20. [PMID: 26669331 PMCID: PMC4730691 DOI: 10.4103/0301-4738.171956] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To study the correlation and effect of sequential measurement of intraocular pressure (IOP) with Goldmann applanation tonometer (GAT), ocular response analyzer (ORA), dynamic contour tonometer (DCT), and Corvis ST. SETTING AND DESIGN Observational cross-sectional series from the comprehensive clinic of a tertiary eye care center seen during December 2012. METHODS One hundred and twenty-five study eyes of 125 patients with normal IOP and biomechanical properties underwent IOP measurement on GAT, DCT, ORA, and Corvis ST; in four different sequences. Patients with high refractive errors, recent surgeries, glaucoma, and corneal disorders were excluded so as to rule out patients with evident altered corneal biomechanics. STATISTICAL ANALYSIS Linear regression and Bland-Altman using MedCalc software. RESULTS Multivariate analysis of variance with repeated measures showed no influence of sequence of device use on IOP (P = 0.85). Linear regression r2 between GAT and Corvis ST, Corvis ST and Goldmann-correlated IOP (IOPg), and DCT and Corvis ST were 0.37 (P = 0.675), 0.63 (P = 0.607), and 0.19 (P = 0.708), respectively. The Bland-Altman agreement of Corvis ST with GAT, corneal compensated IOP, and IOPg was 2 mmHg (-5.0 to + 10.3), -0.5 mmHg (-8.1 to 7.1), and 0.5 mmHg (-6.2 to 7.1), respectively. Intraclass correlation coefficient for repeatability ranged from 0.81 to 0.96. CONCLUSIONS Correlation between Corvis ST and ORA was found to be good and not so with GAT. However, agreement between the devices was statistically insignificant, and no influence of sequence was observed.
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Affiliation(s)
- Sushma Tejwani
- Department of Glaucoma, Narayana Nethralaya, Bengaluru, Karnataka, India
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44
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The Effect of Dehydration and Fasting on Corneal Biomechanical Properties and Intraocular Pressure. Eye Contact Lens 2016; 42:392-394. [DOI: 10.1097/icl.0000000000000220] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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45
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Matalia J, Francis M, Tejwani S, Dudeja G, Rajappa N, Sinha Roy A. Role of Age and Myopia in Simultaneous Assessment of Corneal and Extraocular Tissue Stiffness by Air-Puff Applanation. J Refract Surg 2016; 32:486-93. [DOI: 10.3928/1081597x-20160512-02] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 03/17/2016] [Indexed: 11/20/2022]
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46
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Kilavuzoglu AE, Celebi ARC, Altiparmak UE, Cosar CB. The Effect of Smoking on Corneal Biomechanics. Curr Eye Res 2016; 42:16-20. [PMID: 27261446 DOI: 10.3109/02713683.2016.1145233] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To determine the effect of smoking on corneal biomechanical behavior. MATERIALS AND METHODS The medical records of consecutive patients that presented to the ophthalmology department were reviewed. History of smoking and ophthalmological examination findings were recorded. The smoking group met the following criteria: a clear history of and present smoking habit, negative history of corneal disease and surgery, ocular response analyzer measurement at the time of examination, and a waveform score ≥3.7. Nonsmokers (never smoked or quit smoking ≥6 months earlier) that met the same criteria constituted the control group. Corneal biomechanical parameters were measured using ocular response analyzer. Data were analyzed using Pearson's χ2 test, Mann-Whitney U test, and Spearman's correlation coefficient. RESULTS The smoking group included 166 eyes of 166 patients with a mean age of 38.7 ± 11.95 years, and the control group consisted of 170 eyes of 170 patients with a mean age of 38.40 ± 12.2 years. Mean cumulative smoking dose in the smoking group was 9.59 ± 11.87 pack-years (0.04- 75.00). There was no significant correlation between cumulative smoking dose and corneal hysteresis and corneal resistance factor (P = 0.382 and 0.074, respectively). There were no significant differences in corneal hysteresis or the corneal resistance factor between the two groups (P > 0.05). There was no significant difference in corneal hysteresis between those in the smoking group aged 18-44 years and those aged 45-64 years (P = 0.258), whereas in the control group mean corneal hysteresis was significantly lower in the 45-64 year olds than in the 18-44 year olds (P = 0.034). CONCLUSIONS Although there was no significant difference in corneal biomechanics between smoking and control groups, the decrease in corneal hysteresis with aging was less apparent in the smoking group, which may be due to the potential changes in the cornea's microstructure induced by smoking during aging and the effect of smoking in aged corneal tissue viscosity.
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Affiliation(s)
- Ayse Ebru Kilavuzoglu
- a Ophthalmology Department , Acibadem University School of Medicine , Istanbul , Turkey
| | - Ali Riza Cenk Celebi
- a Ophthalmology Department , Acibadem University School of Medicine , Istanbul , Turkey
| | - Ugur Emrah Altiparmak
- a Ophthalmology Department , Acibadem University School of Medicine , Istanbul , Turkey
| | - Cemile Banu Cosar
- a Ophthalmology Department , Acibadem University School of Medicine , Istanbul , Turkey
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Clement CI, Parker DGA, Goldberg I. Intra-Ocular Pressure Measurement in a Patient with a Thin, Thick or Abnormal Cornea. Open Ophthalmol J 2016; 10:35-43. [PMID: 27014386 PMCID: PMC4780515 DOI: 10.2174/1874364101610010035] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Revised: 08/18/2015] [Accepted: 08/18/2015] [Indexed: 11/23/2022] Open
Abstract
Accurate measurement of intra-ocular pressure is a fundamental component of the ocular examination. The most common method of measuring IOP is by Goldmann applanation tonometry, the accuracy of which is influenced by the thickness and biomechanical properties of the cornea. Algorithms devised to correct for corneal thickness to estimate IOP oversimplify the effects of corneal biomechanics. The viscous and elastic properties of the cornea influence IOP measurements in unpredictable ways, a finding borne out in studies of patients with inherently abnormal and surgically altered corneal biomechanics. Dynamic contour tonometry, rebound tonometry and the ocular response analyzer provide useful alternatives to GAT in patients with abnormal corneas, such as those who have undergone laser vision correction or keratoplasty. This article reviews the various methods of intra-ocular pressure measurement available to the clinician and the ways in which their utility is influenced by variations in corneal thickness and biomechanics.
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Affiliation(s)
- Colin I Clement
- Eye Associates, 4/187 Macquarie Street Sydney NSW 2000, Australia; Glaucoma Unit, Sydney Eye Hospital, Australia; Discipline of Ophthalmology, The University of Sydney, Australia; Gosford and Wyong Eye Surgery, Australia
| | - Douglas G A Parker
- Eye Associates, 4/187 Macquarie Street Sydney NSW 2000, Australia; Gosford and Wyong Eye Surgery, Australia
| | - Ivan Goldberg
- Eye Associates, 4/187 Macquarie Street Sydney NSW 2000, Australia; Glaucoma Unit, Sydney Eye Hospital, Australia; Discipline of Ophthalmology, The University of Sydney, Australia
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Misra SL, Braatvedt GD, Patel DV. Impact of diabetes mellitus on the ocular surface: a review. Clin Exp Ophthalmol 2016; 44:278-88. [DOI: 10.1111/ceo.12690] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 12/05/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Stuti L Misra
- Department of Ophthalmology, New Zealand National Eye Centre Faculty of Medical and Health Sciences; University of Auckland; Auckland New Zealand
| | - Geoffrey D Braatvedt
- Department of Medicine, Faculty of Medical and Health Sciences; University of Auckland; Auckland New Zealand
| | - Dipika V Patel
- Department of Ophthalmology, New Zealand National Eye Centre Faculty of Medical and Health Sciences; University of Auckland; Auckland New Zealand
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49
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Celebi ARC, Kilavuzoglu AE, Altiparmak UE, Cosar CB. Corneal Biomechanical Properties in Aspirin Users. Ophthalmic Res 2016; 55:199-204. [DOI: 10.1159/000443892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 01/09/2016] [Indexed: 11/19/2022]
Abstract
<b><i>Purpose:</i></b> To analyze corneal biomechanical properties in aspirin users using an ocular response analyzer. <b><i>Methods:</i></b> This study included 80 eyes of 40 aspirin users and 80 eyes of 40 individuals who did not use aspirin. Corneal hysteresis (CH), the corneal resistance factor (CRF), Goldman-correlated intraocular pressure (IOPg), and corneal compensated intraocular pressure (IOPcc) were measured in all participants. The independent samples t test was used to compare measurements in the aspirin users and nonusers in the total study population, and in the diabetic patient subgroup. Pearson's correlation analysis was used to examine the relationship between the measured variables in the aspirin users and nonusers. <b><i>Results:</i></b> Aspirin users (59.08 ± 11.83 years) were older than nonusers (39.82 ± 12.97 years; p < 0.001). The mean CH was significantly lower in the aspirin user group than in the nonuser group (p = 0.013). Mean IOPg and mean IOPcc were also significantly higher in the aspirin user group (p = 0.027 and p = 0.002, respectively). The mean CRF was lower in the aspirin user group, but not significantly (p = 0.70). There was a positive correlation between CH and CRF (r = 0.767, p < 0.001), and between CRF and IOPg (r = 0.680, p < 0.001), and a negative correlation between CH and IOPcc (r = -0.415, p < 0.001). <b><i>Conclusions:</i></b> Aspirin should be taken into account when interpreting the results of corneal biomechanical measurements.
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Peña-García P, Peris-Martínez C, Abbouda A, Ruiz-Moreno JM. Detection of subclinical keratoconus through non-contact tonometry and the use of discriminant biomechanical functions. J Biomech 2015; 49:353-63. [PMID: 26777602 DOI: 10.1016/j.jbiomech.2015.12.031] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 12/09/2015] [Accepted: 12/21/2015] [Indexed: 10/22/2022]
Abstract
The purpose of the present study was to develop a discriminant function departing from the biomechanical parameters provided by a non-contact tonometer (Corvis-ST, Oculus Optikgeräte, Wetzlar, Germany) to distinguish subclinical keratoconus from normal eyes. 212 eyes (120 patients) were divided in two groups: 184 healthy eyes of 92 patients aged 32.99 ± 7.85 (21-73 years) and 28 eyes of 28 patients aged 37.79 ± 14.21 (17-75 years) with subclinical keratoconus. The main outcome measures were age, sex, intraocular pressure (IOP), corneal central thickness (CCT) and other specific biomechanical parameters provided by the tonometer. Correlations between all biomechanical parameters and the rest of variables were evaluated. The biomechanical measures were corrected in IOP and CCT (since these variable are not directly related with the corneal structure and biomechanical behavior) to warrant an accurate comparison between both types of eyes. Two discriminant functions were created from the set of corrected variables. The best discriminant function created depended on three parameters: maximum Deformation Amplitude (corrected in IOP and CCT), First Applanation time (corrected in CCT) and CCT. Statistically significant differences were found between groups for this function (p=2·10(-10); Mann-Withney test). The area under the Receiving Operating Characteristic was 0.893 ± 0.028 (95% confidence interval 0.838-0.949). Sensitivity and specificity were 85.7% and 82.07% respectively. These results show that the use of biomechanical parameters provided by non-contact tonometry, previous normalization, combined with the theory of discriminant functions is a useful tool for the detection of subclinical keratoconus.
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Affiliation(s)
- Pablo Peña-García
- Department of Ophthalmology, Castilla La Mancha University, Albacete, Spain.
| | - Cristina Peris-Martínez
- Fisabio Oftalmologia Médica (FOM), Cornea and Anterior Segment Diseases Unit, Valencia, Spain; Eye Clinic Aviñó-Peris, Valencia, Spain
| | | | - José M Ruiz-Moreno
- Department of Ophthalmology, Castilla La Mancha University, Albacete, Spain
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