Evaluation of eye health in children with type 1 diabetes mellitus and celiac disease

Abstract

Background: Pediatric celiac disease (CeD) and type 1 diabetes mellitus (T1DM) have well established effects on eye health but comorbid effect is not known. Aim: To evaluate the eye health of children with T1DM and CeD to predict microvascular retinal pathologies by diagnosis of probable intraocular pressure increase which is an important glaucoma trigger. Patients and Methods: In this case-controlled study, 28 eyes of 14 children both T1DM and CeD, with a mean age of 12.6 ± 3.9 years, and 28 eyes of gender-matched 14 healthy children as a control group were included. In both groups, detailed ocular examinations and measurement of intraocular pressure (IOP), ocular pulse amplitude (OPA), thicknesses of ganglion cell layer (GCL), inner plexiform layer (IPL), retinal nerve fiber layer (RNFL), and choroid thicknesses (CT) were done. All the patients with T1DM and CeD were newly diagnosed. The evaluations of IOP and OPA were made using a Pascal dynamic tonometer and thicknesses measured by optical coherence tomography. Results: The IOP and OPA values of the patient group were found to be statistically significantly higher than those of the control group (17.1 and 1.86 vs 14.78 and 1.57 mmHg, P <.0001, P <.001, respectively). IOP values of all patients were higher than IOP cut off levels for diagnosis of hypertension. CT was significantly thinner in the patient group than in the control group (385.4 μm vs 331.71 μm, respectively, P < 0.03). No significant difference was found between the groups in respect of GCL, IPL, and RNFL values. Conclusion: The higher IOP and OPA values of the children with T1DM and CeD were considered to be the result of the microvascular pathologies in T1DM and increased inflammation associated with CeD. High IOP and OPA values can lead to damage in the eye as intraocular blood flow and choroidal perfusion are affected. In order to prevent these eye problems, measurement of IOP and OPA should be done in children with diagnosis of T1DM and CeD and also follow up studies needed.

Central Corneal Thickness and Intraocular Pressure in Children with Type 1 Diabetes Mellitus

“…The mean IOP was also higher in the T1DM group than in the control group. Dereci et al [ 13 ] and Akil et al [ 15 ] reported similar findings in their studies. This can potentially be attributed to persistent hyperglycemia, which is thought to cause excessive extracellular matrix synthesis in the trabecular meshwork, sequentially causing outflow obstruction of the aqueous humor in the anterior segment of the eye and elevating intraocular pressure [ 17 ].…”

“…In addition, it is thought that the accumulation of reactive oxygen species, advanced glycated end products, and growth factors induce the activation and proliferation of corneal stromal keratocytes [16]. In contrast, studies by Dereci et al [13] and Wang et al [14] report lower mean CCT values in children with T1DM than the control group in their study. Wang et al [14] argue that low CCT values were due to apoptosis and cell death resulting from hyperglycemia.…”

“…This finding is congruent with a study on CCT conducted by Urban et al [ 10 ] and a study on IOP conducted by Akil et al [ 15 ]. It has been postulated that the effect of T1DM on ocular tissues is time dependent [ 13 ]. Dujic and Ignjatovic [ 19 ] reported risk of severe eye complications with T1DM 10 years after developing the disease.…”

“…Several previous studies conducted in Europe, North Africa, Central Asia, and South Asia investigate the links between CCT and IOP in children with T1DM. These studies are summarized in Table 4[10][11][12][13][14][15].…”