Abstract
Purpose :
The aim of this study was to quantify abnormalities in corneal epithelial, stromal and endothelial cell density and sub-basal nerve fiber morphology over 2 years in young patients with type 1 diabetes mellitus (T1DM) with (DR) and without diabetic retinopathy using in vivo corneal confocal microscopy (CCM).
Methods :
19 young T1DM patients (12 male and 8 female; mean age: 20.03±13.5 years) with DR (n=7) and without DR (n=12) and 19 age and sex-matched healthy control subjects (10 male and 8 female; mean age: 22.56±13.7 years) underwent in vivo CCM examination at baseline and at 2 years follow-up. Corneal nerve fiber density (CNFD), length (CNFL), area (CNFA), width (CNFW), branch density (CNBD) and total branch density (CTBD) were analyzed using automated software (ACCMetrics) epithelial, keratocyte and endothelial cell densities were analyzed using semi-automated software by the same skilled examiner.
Results :
There was a significant reduction in epithelial cell density (p=0.05) with a significant increase in keratocyte cell density (p=0.002) and no change in endothelial cell density over 2 years. CNFD (p=0.002) and CNFL (p=0.006) showed a significant reduction, especially in T1DM patients without retinopathy. There was a non-significant increase in HbA1c (without DR (68.25±17.07 vs 71.16±15.07 mmol/mol, with DR (72.80±20.24 vs 75.84±4.97 mmol/mol)) and cholesterol (without DR 4.32±0.58 vs 4.58±0.89 mmol/L, with DR (4.88±0.57 vs 5.4±0.33 mmol/L)) over 2 years. Triglyceride levels, HDL, eGFR and blood pressure did not show any change.
Conclusions :
Our finding suggests that in vivo CCM can detect progressive corneal epithelial, stromal and nerve fiber loss over a relatively short period in young patients with T1DM. This study support the role of in vivo CCM in following up patients with diabetes mellitus as a part of routine ophthalmological examination.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.