Alper BAYAT, Şeyma ÖZTURAN, Akin CAKİR, Selim BÖLÜKBASİ, Burak ERDEN, Diğdem BEZEN, Mustafa ELCİOĞLU

Corneal endothelial morphology and anterior segment parameters in children with type 1 diabetes mellitus

Background and objectives. To compare the corneal endothelial morphology and anterior segment parameters in type 1 diabetes mellitus children (T1DM) and healthy controls.Methods. This cross-sectional prospective study included 56 patients with T1DM and 50 eyes of 50 age-matched controls. Endothelial morphology was analyzed with EM-3000 specular microscopy, and anterior parameters were analyzed with Sirius Scheimpflug topography. Endothelial cell density (ECD), coefficient of variation (CV) of cell area, central corneal thickness (CCT), anterior chamber depth (ACD), iridocorneal angle (ICA), K1 and K2, pupillary diameter (PD), horizontal visible iris diameter (HVID), duration of T1DM, and HbA1c levels were noted. Results. The mean age of the T1DM group was 14.3 ± 3.2 years, compared to 13.2 ± 3.7 years in the healthy group (p = 0.140). The mean duration of diabetes mellitus was 4.5 ± 3.5 years. The mean HbA1c was 9.5 ± 1.9% (minimum 6%, maximum 14%). The mean values of CCT were 556 ± 30 μm and 536 ± 36 μm in T1DM and healthy groups, respectively (p = 0.003). The mean values of ACD were 3.69 ± 0.31 mm and 3.83 ± 0.27 mm in T1DM and healthy groups, respectively (p = 0.02). The mean values of PD were 4.29 ± 1.2 mm and 5.17 ± 1.36 mm in T1DM and healthy groups, respectively (p = 0.001). There was no statistically significant difference between groups in terms of ECD, CV, ICA, K1, K2, and HVID (p > 0.05).Conclusion. Type 1 diabetes mellitus children have thicker corneas, shallower anterior chamber depth, and smaller pupillary diameter than healthy subjects.

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1. Patterson C, Guariguata L, Dahlquist G, Soltész G, Ogle G, Silink M. Diabetes in the young - a global view and worldwide estimates of numbers of children with type 1 diabetes. Diabetes Res Clin Pract 2014; 103: 161-175.

2. Yeşilkaya E, Cinaz P, Andıran N, et al. First report on the nationwide incidence and prevalence of Type 1 diabetes among children in Turkey. Diabet Med 2017; 34: 405-410.

3. El-Ziny MAEM, Salem NAB, El-Hawary AK, Chalaby NB, Elsharkawy AAE. Epidemiology of childhood type 1 diabetes mellitus in Nile Delta, northern Egypt-a retrospective study. J Clin Res in Pediatr Endocrinol 2014; 6: 9-15.

4. Misra R, Fitch C, Roberts D, Wright D. Communitybased diabetes screening and risk assessment in rural west Virginia. J Diabetes Res 2016; 2016: 2456518.

5. Imkampe AK, Gulliford MC. Trends in Type 1 diabetes incidence in the UK in 0- to 14-year-olds and in 15- to 34-year olds,1991–2008. Diabet Med 2011; 28: 811-814.

6. Geloneck MM, Forbes BJ, Shaffer CJ, Ying GS, Binenbaum G. Ocular complications in children with diabetes mellitus. Ophthalmology 2015; 122: 2457-2464.

7. Wiemer NG, Dubbelman M, Kostense PJ, Ringens PJ, Polak BC. The influence of diabetes mellitus type 1 and 2 on the thickness, shape, and equivalent refractive index of the human crystalline lens. Ophthalmology 2008; 115: 1679-1686.

8. Wiemer NG, Dubbelman M, Hermans EA, Ringens PJ, Polak BC. Changes in the internal structure of the human crystalline lens with diabetes mellitus type 1 and type 2. Ophthalmology 2008; 115: 2017-2023.

9. Raitelaitiene R, Paunksnis A, Ivanov L, Kurapkiene S. Ultrasonic and biochemical evaluation of human diabetic lens. Medicina (Kaunas) 2005; 41: 641-648.

10. Saw SM, Wong TY, Ting S, Foong AW, Foster PJ. The relationship between anterior chamber depth and the presence of diabetes in the Tanjong Pagar Survey. Am J Ophthalmol 2007; 144: 325-326.

11. Wiemer NG, Dubbelman M, Kostense PJ, Ringens PJ, Polak BC. The influence of chronic diabetes mellitus on the thickness and the shape of the anterior and posterior surface of the cornea. Cornea 2007; 26: 1165-1170.

12. Pittasch D, Lobmann R, Behrens-Baumann W, Lehnert H. Pupil signs of sympathetic autonomic neuropathy in patients with type 1 diabetes. Diabetes Care 2002; 25: 1545-1550.

13. Lei HL, Yang KJ, Sun CC, et al. Obtained mydriasis in long-term type 2 diabetic patients. J Ocul Pharmacol Ther 2011; 27: 599-602.

14. Lachin JM, Genuth S, Cleary P, Davis MD, Nathan DM; Diabetes Control and Complications Trial/ Epidemiology of Diabetes Interventions and Complications Research Group. Retinopathy and nephropathy in patients with type 1 diabetes four years after trial of intensive therapy. N Engl J Med 2000; 432: 381-389.

15. Uzel MM, Elgin U, Sen E, Keskin M, Sağsak E, Aycan Z. Comparison of anterior segment parameters in juvenile diabetes mellitus and healthy eyes. Eur J Ophthalmol 2016; 26: 618-622.

16. Anbar M, Ammar H, Mahmoud RA. Corneal endothelial morphology in children with type 1 diabetes. J Diabetes Res 2016; 2016: 7319047.

17. Larsson LI, Bourne WM, Pach JM, Brubaker RF. Structure and function of the corneal endothelium in diabetes mellitus type I and type II. Arch Ophthalmol 1996; 114: 9-14.

18. Ozdamar Y, Cankaya B, Ozalp S, Acaroglu G, Karakaya J, Ozkan SS. Is there a correlation between diabetes mellitus and central corneal thickness? J Glaucoma 2010; 19: 613-616.

19. Urban B, Raczynska D, Bakunowicz-Lazarczyk A, Raczynska K, Krętowska M. Evaluation of corneal endothelium in children and adolescents with type 1 diabetes mellitus. Mediators Inflamm 2013; 2013: 913754.

20. Tiutiuca C. Assessment of central corneal thickness in children with diabetus mellitus type I. Oftalmologia 2013; 57: 26-32.

21. Busted N, Olsen T, Schmitz O. Clinical observations on the corneal thickness and the corneal endothelium in diabetes mellitus. Br J Ophthalmol 1981; 65: 687- 690.

22. Lee JS, Oum BS, Choi HY, Lee JE, Cho BM. Differences in corneal thickness and corneal endothelium related to duration in diabetes. Eye (Lond) 2006; 20: 315-318.