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Indian Journal of Clinical and Experimental Ophthalmology


A study of corneal changes –endothelial cell density (ECD) and central corneal thickness (CCT) in Type -2 DM in relation to Hba1c levels and compare it with healthy individuals


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Author Details: Manisha Gupta, AN Pandey, Rupali Tyagi

Volume : 2

Issue : 2

Online ISSN : 2395-1451

Print ISSN : 2395-1443

Article First Page : 123

Article End Page : 127


Abstract

Background: Diabetes in India is very common chronic systemic disease which causes wide range of ocular complications. Besides, diabetic retinopathy, patients with diabetes are prone to developing corneal endothelial damage, corneal oedema, epithelial changes like keratoepitheliopathy in the form of recurrent corneal erosions, persistent epithelial defects, and superficial keratitis.
Objectives: The aim of this study was to measure the central corneal thickness and ECD in type -2 DM in relation to Hba1c levels and compare with healthy individuals of same age group.
Material and Methods: It was a hospital based, prospective case-control study. A total of 120 patients, 50-70 yrs of age, participated in the study, of whom 60 were diabetic type 2 on oral hypoglycemic already established from  medicine department and 60 healthy individuals of same age group attended eye OPD were taken after taking Consents from patients at medical college in Uttarakhand,  and approval from ethical committee. Study group was divided into two groups – diabetic type 2 (with Hba1c <7 and >7) and healthy individuals. After thorough ocular examination include slit lamp and fundus examination, the central corneal thickness and endothelial cell count (ECD) was measured using specular/ pachymetry nidek machine. Exclusion criteria was any corneal pathology, ocular surgery, trauma any other systemic illness, insulin dependent, on topical drops.
Results: Mean CCT was thicker in diabetic group (575.53μm) when compared to non-diabetic group (560.40μm). The difference between the 2 groups was significant (p<0.001). Mean CCT in diabetic patients was 575.53±7.8μm. Mean duration of diabetes was 9.53±1.9 yrs. The relation between CCT and duration of diabetes was not significant. A statistically significant difference (p=0.001) was found in the endothelial cell density (ECD), between diseased and normal eyes. When the patients were analyzed in terms of HbA1c levels, patients with HbA1c levels over 7% had thicker corneas and lower ECD values than the patients with HbA1c levels under 7% (p=0.031).
Conclusion: In diabetic patients central corneal thickness was more compared to non diabetics. Therefore, diabetes can increase the CCT but there is no significant correlation between duration of diabetes and CCT. A lower ECD was seen in diabetic patients compared to healthy adults which was in turn influenced by poor glycemic control Hba1c>7 and duration of diabetes.

Keywords:
Central Corneal thickness1, Pachymetry3, Specularmicroscopy4, Endothelial Cell Density2