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David Larson DeMill, Munira Hussain, Rodica Pop-Busui, Roni M Shtein; Ocular Surface Disease in Patients with Diabetic Peripheral Neuropathy. Invest. Ophthalmol. Vis. Sci. 2014;55(13):1483.
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To analyze clinical signs and symptoms of ocular surface disease in patients with diabetes mellitus (DM), based on severity of diabetic peripheral neuropathy.
This cross-sectional study included 35 participants who were carefully phenotyped by a multidisciplinary team and separated into 3 groups: patients with DM and mild or no peripheral neuropathy (Group 1), patients with DM and severe peripheral neuropathy (Group 2), and age-matched healthy controls (Group 3). All study participants completed the Ocular Surface Disease Index (OSDI) and underwent clinical testing for: tear osmolarity, fluorescein and lissamine green staining, tear break up time, corneal sensitivity, Schirmer’s test, and confocal microscopy for corneal nerve length and basal epithelial cell density. STATA was used for statistical analysis. ANOVA was used to analyze differences between groups depending on severity of peripheral neuropathy and correlation testing was performed between areas of interest, using the Bonferroni correction for multiple comparisons.
Significant differences were noted between the 3 groups with tear osmolarity (299.4 mOsmol/L in Group 1, 312.5 mOsmol/L in Group 2, and 291.7 mOsmol/L in Group 3; p = .007), Schirmer’s test (10.7 mm in Group 1, 12.2 mm in Group 2, and 20.1 mm in Group 3, p = 0.019) and corneal nerve length (17.9 mm/mm2 in Group 1, 11.8 mm/mm2 in Group 2, and 20.8 mm/mm2 in Group 3, p = 0.004). No significant differences were found between the 3 groups when comparing the OSDI score, tear break up time, corneal sensitivity, basal epithelial cell density, and fluorescein or lissamine green staining. No statistically significant correlations were noted between the OSDI and clinical signs of dry eyes. Likewise no significant correlations were present between corneal nerve length and clinical signs of dry eyes or corneal sensation.
This pilot study confirms that patients with DM have decreased Schirmer’s test results and increased tear osmolarity when compared to healthy controls, and that tear osmolarity increases with severity of peripheral neuropathy. Even though there were increased clinical findings of ocular surface disease with increasing severity of peripheral neuropathy, dry eye symptoms were not significantly different based on severity of peripheral neuropathy. Furthermore, no significant correlations were found between the OSDI results and clinical signs of dry eye.
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