Tianjin Medical University Eye Hospital, Tianjin Medical University Eye Institute &School of Optometry and Ophthalmology, Tianjin Medical University, Tianjin, 300384, China.
Cont Lens Anterior Eye. 2019 Aug;42(4):380-385. doi: 10.1016/j.clae.2019.02.011. Epub 2019 Apr 25.
To investigate the relationship between the duration of type 2 diabetes mellitus (DM) and the ocular surface, and to address the question of why some people with lengthy DM duration are asymptomatic, whereas some people with shorter DM duration have pain or discomfort in their eyes.
Eighty-seven eyes of 87 subjects with different durations of DM and 49 eyes of 49 subjects without DM underwent Schirmer I test, tear film break-up time, sodium fluorescein staining and tear meniscus height (TMH) measurement, and completed the Standardized Patient Evaluation of Eye Dryness (SPEED) questionnaire. Corneal structure and function were assessed with in vivo confocal corneal microscopy and with a corneal sensitivity esthesiometer. Both corneal nerve fiber length and inferior whorl length (IWL) were assessed as indices for neural structure. Age and gender were matched between groups. HbA1c levels >7.8% and proliferative diabetic retinopathy were exclusion criteria.
In the DM group, compared with the non-DM group, the SPEED score was significantly higher (p = 0.013), and corneal sensitivity and IWL were lower (p < 0.001). Schirmer I test, corneal sensitivity and IWL differed significantly between the group with DM duration >10 years and the non-DM (control) group (p = 0.021, p < 0.001, p < 0.001, respectively). Schirmer I test and IWL were significantly lower in the group with DM >10 years than in the group with DM ≤10 years (p = 0.023, p < 0.001, respectively). Corneal sensitivity was positively correlated with IWL regardless of diabetes status.
The lower SPEED score and asymptomatic feeling in people with a longer DM duration may be explained by the decreased IWL and reduced sensitivity.
探讨 2 型糖尿病（DM）持续时间与眼表的关系，并解答为什么一些 DM 持续时间较长的人无症状，而一些 DM 持续时间较短的人眼睛疼痛或不适的问题。
对 87 例不同 DM 持续时间的患者的 87 只眼和 49 例无 DM 的患者的 49 只眼进行了 Schirmer I 试验、泪膜破裂时间、荧光素钠染色和泪膜新月高度（TMH）测量，并完成了标准化患者眼干燥评估（SPEED）问卷。应用共焦角膜显微镜和角膜知觉仪评估角膜结构和功能。角膜神经纤维长度和下涡长度（IWL）均作为神经结构的指标进行评估。两组的年龄和性别相匹配。HbA1c 水平>7.8%和增殖性糖尿病视网膜病变为排除标准。
在 DM 组中，与非 DM 组相比，SPEED 评分明显较高（p=0.013），角膜敏感性和 IWL 较低（p<0.001）。DM 持续时间>10 年组与非 DM（对照组）组之间的 Schirmer I 试验、角膜敏感性和 IWL 差异有统计学意义（p=0.021，p<0.001，p<0.001，分别）。DM >10 年组的 Schirmer I 试验和 IWL 明显低于 DM ≤10 年组（p=0.023，p<0.001，分别）。无论糖尿病状态如何，角膜敏感性均与 IWL 呈正相关。
DM 持续时间较长的人群 SPEED 评分较低且无症状感觉可能是由于 IWL 降低和敏感性降低所致。
