Department of Ophthalmology, S.P. Medical College, PBM Hospital, Bikaner, Rajasthan, India.
Indian J Ophthalmol. 2021 May;69(5):1080-1083. doi: 10.4103/ijo.IJO_1764_20.
Chronic kidney disease (CKD) is an emerging health problem worldwide. In CKD corneal endothelial changes also occur probably due to accumulation of inflammatory cytokines and increased multiple toxic products. The aim of this study was to analyze the effect of CKD on corneal endothelium and correlate the findings with severity of disease with help of noninvasive technique.
The study comprised 75 eyes of 75 cases divided into three groups with group A comprising of CKD cases on dialysis, group B of nondialysis CKD cases, and group C of controls. Each group had 25 cases each of either sex and between 15-80 age groups. All patients were investigated for blood urea, serum creatinine, and blood sugar and underwent complete ophthalmic examination of both eyes along with wide-field specular microscopy examination.
The majority of patients (33.3%) belonged to age range of 61-70 years with male predominance and the most common cause of CKD was found to be diabetes with 17 (34%) cases. We found normal corneal endothelial cell density (ECD) with the mean ECD of 2364.52 ± 397.72 mm in the dialysis group, 2467.8 ± 352.88 mm in nondialysis group, and 2521.68 ± 250.26 mm in the control group of patients. However, we found significant increase in coefficient of variation (CV) with 36 ± 5.8% in dialysis group, 37 ± 4.5% in nondialysis group and 32 ± 0.8% in controls (P = 0.001) and decreased hexagonality (Hx) with 47 ± 7.3% in dialysis group, 46 ± 4.7% in nondialysis group and 51 ± 6.7% in the controls (P = 0.031). This showed increased tendency of pleomorphism and polymegathism in corneal endothelial cells in CKD cases. No correlation was found between blood urea or serum creatinine levels with endothelial parameters in any group.
CKD causes morphological changes like polymegathism and pleomorphism in corneal endothelium and hence these cases are more vulnerable and special care should be taken before any intraocular surgical procedure.
慢性肾脏病（CKD）是全球范围内日益严重的健康问题。在 CKD 中，角膜内皮也会发生变化，可能是由于炎症细胞因子的积累和多种毒性产物的增加。本研究旨在分析 CKD 对角膜内皮的影响，并通过非侵入性技术将这些发现与疾病的严重程度相关联。
该研究共纳入 75 例 75 只眼，分为三组，A 组为透析的 CKD 患者，B 组为非透析 CKD 患者，C 组为对照组。每组各有 25 例，男女各半，年龄在 15-80 岁之间。所有患者均进行了血尿素、血清肌酐和血糖检查，并对双眼进行了全面的眼科检查和广角共焦显微镜检查。
大多数患者（33.3%）年龄在 61-70 岁之间，男性居多，最常见的 CKD 病因是糖尿病，有 17 例（34%）。我们发现透析组角膜内皮细胞密度（ECD）正常，平均 ECD 为 2364.52±397.72mm，非透析组为 2467.8±352.88mm，对照组为 2521.68±250.26mm。然而，我们发现变异系数（CV）显著增加，透析组为 36±5.8%，非透析组为 37±4.5%，对照组为 32±0.8%（P=0.001），六角形（Hx）下降，透析组为 47±7.3%，非透析组为 46±4.7%，对照组为 51±6.7%（P=0.031）。这表明 CKD 病例中角膜内皮细胞的多形性和多核化趋势增加。在任何一组中，都没有发现血尿素或血清肌酐水平与内皮参数之间存在相关性。
CKD 导致角膜内皮形态发生变化，如多核化和多形性，因此这些病例更脆弱，在进行任何眼内手术前应特别注意。
