Corneal Endothelial Morphology in Children with Type 1 Diabetes

Abstract

Aim. To investigate corneal endothelial cell morphological in children with type 1 diabetes and to determine the systemic and local factors that contribute to these changes. Methods. One hundred sixty eyes of 80 children with type 1 diabetes and 80 eyes of 40 normal children as a control during the period from July 2015 to February 2016 underwent full clinical and ophthalmologic examination. We measured the central corneal thickness (CCT), endothelial cell density (ECD), ploymegathism, and pleomorphism using a noncontact specular microscope. Results. The mean age of the diabetic children was 8.22 ± 3.11 years. The mean duration of type 1 diabetes was 3.51 ± 2.23 years. The mean CCT was significantly higher: 537 ± 33.41 microns (right eye), in the diabetic group compared to the control group. The mean ECD in patients with type 1 diabetes was 3149.84 ± 343.75 cells/mm2 (right eye), and it was significantly lower than in the control group. Furthermore, pleomorphism was significantly lower 48.73 ± 5.43% (right eye), in the diabetic group compared to the control group. The mean polymegathism was significantly higher 37.96 ± 5.61% (right eye), in the diabetic group compared to the control group. All of these changes are significantly correlated only with the duration of diabetes. Conclusions. Diabetic children have thicker corneas, lower ECD, an increased polymegathism, and a decreased pleomorphism. The duration of diabetes is the factor that affects all of these changes. To what extent these changes affect visional function on long term needs to be investigated in further studies.

Central Corneal Thickness can be Related to Diabetic Peripheral Neuropathy in Children with Type 1 Diabetes

“…In the present study, higher CCT values were observed in pediatric patients with T1D after several years of its duration in comparison to the values found in healthy children without any glucose tolerance disorders. Many authors emphasize higher CCT index in patients with T1D compared to subjects without glucose tolerance disorders [17][18][19][20]. But, in our study the CCT results in type 1 diabetic patients did not correlate either with HbA1c, glucose levels and their fluctuations or with C peptide concentrations, daily insulin intake, diabetes duration and age of the patients.…”

“…Other studies performed in the group of healthy subjects and patients with diabetes showed statistically significant differences in CCT thickness related to hyperglycemia, metabolic control of diabetes and disease duration. In patients with a higher HbA1c level and longer diabetes duration increased CCT values were observed in comparison to control groups [8,9,17,18].…”

“…It is also known that chronic hyperglycemia present in T1D patients can be a cause of non-enzymatic glycation of proteins in many tissues including both the visual organ and nervous system which results in concurrent changes in the two systems [25]. The cornea thickening may be caused by increased protein glycation including collagen cross-linking as well as stromal hydration with corneal edema [18,26].…”

Measurement of corneal thickness, optic nerve sheath diameter and retinal nerve fiber layer as potential new non-invasive methods in assessing a risk of cerebral edema in type 1 diabetes in children

“…Other studies conducted in the group of healthy children and adult patients as well as patients with diabetes showed statistically significant differences in CCT thickness related to hyperglycemia, metabolic control of diabetes and disease duration. In patients with a higher percentage of HbA1c [ 17 ] and longer duration of the disease, higher CCT values were observed in comparison with control groups [ 14 , 15 , 18 ]. All authors emphasize higher CCT dimensions in patients with T1D compared to subjects without glucose tolerance disorders [ 14 , 15 , 17 – 20 ].…”

Corneal Confocal Microscopy detects a Reduction in Corneal Endothelial Cells and Nerve Fibres in Patients with Acute Ischemic Stroke

“…However, it produces comparable type and amount of extracellular matrix and collagen to aortic and venous endothelium 21 , and exposure of corneal endothelial cells to fibrin 22 or thrombin 23 leads to the induction of tissue-plasminogen activator. Non-contact specular microscopy has been used to identify a reduction in corneal endothelial cell density and increased polymegathism in some studies of patients with Type 2 diabetes 24 and children with Type 1 diabetes 25 , but not in others 26 .…”