Abstract

Background:Diabetes mellitus has been postulated to alter the morphology of the
cornea.Aim of our study was to compare the morphological characteristics of corneal
endothelial cellsin type 2 diabetic patients with age-matched healthy subjects. We also
determined the association of corneal morphological features with the general
characteristics and laboratory data of diabetic patients, including disease duration,
urine albumin creatinine ratio.
Methods:A case-control study in a tertiary care hospital of northwestern India with a
total of 50 diabetic patients and 50 healthy controls were enrolled in the study. All
participants underwent a complete ophthalmological examination. Corneal endothelial
measurements were performed using a noncontact specular microscopy. Laboratory
data including serum fasting glucose, --HbA1c levels, creatinine levels, and the urinary
albumin-to-creatinine ratio were recorded. Diabetic patients were further subdivided
into 3 groups according to the presence and stage of diabetic retinopathy. Specular
microscopy findings and central corneal thickness of all patients were compared.
Results: The ECD and hexagonal cell ratio were significantly lower, while the average
cell size, CV%, and central corneal thickness were determined to be significantly higher
in diabetic patients than in healthy controls (p = 0.001). With the presence and
advancement of diabetic retinopathy, the ECD and hexagonal cell ratio decreased, while
the average cell size, CV%, and central corneal thickness increased. When correlation
analysis was performed between corneal morphological features and laboratory data of
diabetic patients, ECD showed a significant negative correlation with diabetes duration
(p = 0.028). Urinary albumin-creatinine ratio (p = 0.041), average cell size and CV
showed a positive correlation with these parameters.
Conclusion: In conclusion, keratopathy is an important complication of type 2 diabetes.
With an increase in the stage of diabetic retinopathy, alterations in corneal findings also
increased. In that respect, we can suggest that keratopathy should be evaluated more
cautiously in diabetic patients.