Diabetic complications in the cornea

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.

Clinical features of patients with diabetic anterior uveitis

“…Since the intraocular pressure (IOP) was slightly high (range 23–28 mm Hg) in three of the seven eyes, and normal (14–19 mm Hg) in the remaining four eyes, the Descemet folds were not related to hypotony. It has been reported that various corneal complications including endothelial dysfunction are observed in patients with DM 15. In addition, all seven eyes with Descemet folds in our study had severe inflammatory findings such as fibrin formation (six eyes) and/or 3+ or greater anterior chamber cells (four eyes).…”

Unravelling the stromal-nerve interactions in the human diabetic cornea

“…Insulin growth factor 1(IGF1) and its receptor (IGF1-R) are key modulators during various vital cellular processes including cellular differentiation, proliferation, survival and metabolism in various array of cell types (Ljubimov, 2017). They are also known to play a role in DM as well as diabetic keratopathy (Ljubimov, 2017).…”

“…They are also known to play a role in DM as well as diabetic keratopathy (Ljubimov, 2017). In this study we found significant upregulation of IGF1 expression in T2DM control (Fig.…”

Study of impact of diabetes mellitus on corneal central thickness and endothelial parameters in Indian eyes

“…Though the cornea appears normal, significant biochemical changes occur which alter the function of cornea. Advanced glycation end products (AGEs) [1][2][3][4] and matrix metalloproteinases (MMP) have been proposed to be the cause for corneal damage. The accumulation of AGEs enhanced the apoptosis of retinal pericytes, corneal endothelial cells, neuronal cells, and renal mesangial cells.…”