Abstract
Purpose :
Dry Eye Disease (DED) has a complex pathophysiology, build up on knowledge that, among others, impaired peripheral sensitivity; neuroautonomic disorders and inflammation act as pivotal mechanisms. Charcot arthropathy (CA), a rare and late diabetic complication, shares similar pathological background with DED and severe peripheral sensitivity impairment (PSI) and autonomic cardiovascular neuropathy (ACP). The aim of this study was to assess diagnosis and severity of DED, ocular surface and tear film.
Methods :
This study included a total of 25 (CA) diabetic patients were compared to 10 non-diabetic patients. Ocular surface evaluation and DED were investigated with OSDI questionnaire; Schirmer 1 test, fluorescein and lissamine green staining evaluated by clinical exam; non-invasive break-up time, lacrimal meniscus height, surface hyperemia, meibography and pupillogram evaluated by Oculus Keratograph 4 (OCULUS Optikgeräte GmbH, Wetzlar, Germany). Tear samples were collected to metalloproteinases (MMP) and substance P concentration measurements.
Results :
CA patients presented mild/moderate DED (82.3%). Some parameters had no difference, such as tear meniscus height, noninvasive break up time (NITBUT) and bulbar redness. Tear samples showed a statistically significant different on the concentration of peptides MMP1 (p<0,004) and MMP7 (p<0,004) when compared the control group with CA patients. No correlation was shown in peptides MMP2, MMP9 and MMP10. The analysis on substance P was inconclusive. Pupillogram measures were statistically lower in CA patients than in control group (min size 1.75 vs 2.8 mm p<0.008; mean 3.0 vs 4.45 mm p<0.0009; max 3.35 vs 5.65 mm p<0.002) and correlated with PSI and ACP.
Conclusions :
CA diabetic patients presented DED and ocular surface dysfunction that seems to be influenced by the inflammatory factors in tear film and neuroautonomic associated disorders. Pupillogram measures were lower in CA patients than in control group, which suggests association between systemic and ocular neuroautonomic impairment.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.