Department of Ophthalmology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil.
Endocrinology Division, Department of Internal Medicine (Endocrinology), School of Medical Sciences, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil.
Front Endocrinol (Lausanne). 2021 Apr 21;12:585823. doi: 10.3389/fendo.2021.585823. eCollection 2021.
Diabetes can affect the eye in many ways beyond retinopathy. This study sought to evaluate ocular disease and determine any associations with peripheral neuropathy (PN) or cardiac autonomic neuropathy (CAN) in type 2 diabetes (T2D) and Charcot arthropathy (CA) patients.
A total of 60 participants were included, 16 of whom were individuals with T2D/CA, 21 of whom were individuals with T2D who did not have CA, and 23 of whom were healthy controls. Ocular surface evaluations were performed, and cases of dry eye disease (DED) were determined using the Ocular Surface Disease Index (OSDI) questionnaire, ocular surface staining, Schirmer test, and Oculus Keratograph 5M exams. All variables were used to classify DED and ocular surface disorders such as aqueous deficiency, lipid deficiency, inflammation, and ocular surface damage. Pupillary and retinal nerve fiber measurements were added to the protocol in order to broaden the scope of the neurosensory ocular evaluation. PN and CAN were ascertained by clinical examinations involving the Neuropathy Disability Score (for PN) and Ewing's battery (for CAN).
Most ocular variables evaluated herein differed significantly between T2D patients and controls. When the controls were respectively compared to patients with T2D and to patients with both T2D and CA, they differed substantially in terms of visual acuity (0.92 ± 0.11, 0.73 ± 0.27, and 0.47 ± 0.26, p=0.001), retinal nerve fiber layer thickness (96.83 ± 6.91, 89.25 ± 10.44, and 80.37 ± 11.67 µm, p=0.03), pupillometry results (4.10 ± 0.61, 3.48 ± 0.88, and 2.75 ± 0.81 mm, p=0.0001), and dry eye symptoms (9.19 ± 11.71, 19.83 ± 19.08, and 24.82 ± 24.40, p=0.03). DED and ocular surface damage also differed between individuals with and without CA, and were associated with PN and CAN.
CA was found to be significantly associated with the severity of ocular findings. DED in cases of CA was also associated with PN and CAN. These findings suggest that intrinsic and complex neurosensory impairment in the eyes, peripheral sensory nerves, and the autonomic nervous system are somehow connected. Thus, a thorough ocular evaluation may be useful to highlight neurological complications and the impact of diabetes on ocular and systemic functions and structures.
糖尿病可通过多种方式影响眼睛，而不仅仅是视网膜病变。本研究旨在评估眼部疾病，并确定 2 型糖尿病（T2D）和夏科氏关节病（CA）患者的周围神经病变（PN）或心脏自主神经病变（CAN）与眼部疾病之间的关系。
共纳入 60 名参与者，其中 16 名为 T2D/CA 患者，21 名为无 CA 的 T2D 患者，23 名为健康对照组。进行了眼表评估，并通过眼表疾病指数（OSDI）问卷、眼表面染色、泪液分泌试验和 Oculus Keratograph 5M 检查来确定干眼症（DED）病例。所有变量均用于分类 DED 和眼表面疾病，如水性缺乏、脂质缺乏、炎症和眼表面损伤。为了扩大神经感觉眼评估的范围，在方案中增加了瞳孔和视网膜神经纤维测量。PN 和 CAN 通过涉及神经病变残疾评分（用于 PN）和尤因氏电池（用于 CAN）的临床检查来确定。
本文评估的大多数眼部变量在 T2D 患者和对照组之间有显著差异。当将对照组分别与 T2D 患者和同时患有 T2D 和 CA 的患者进行比较时，他们的视力（0.92 ± 0.11、0.73 ± 0.27 和 0.47 ± 0.26，p=0.001）、视网膜神经纤维层厚度（96.83 ± 6.91、89.25 ± 10.44 和 80.37 ± 11.67 µm，p=0.03）、瞳孔测量结果（4.10 ± 0.61、3.48 ± 0.88 和 2.75 ± 0.81，p=0.0001）和干眼症症状（9.19 ± 11.71、19.83 ± 19.08 和 24.82 ± 24.40，p=0.03）有明显差异。患有和不患有 CA 的患者之间的 DED 和眼表面损伤也存在差异，并且与 PN 和 CAN 相关。
CA 与眼部发现的严重程度显著相关。CA 中的 DED 也与 PN 和 CAN 相关。这些发现表明，眼睛、周围感觉神经和自主神经系统的内在和复杂的神经感觉损伤之间存在某种联系。因此，全面的眼部评估可能有助于突出神经并发症以及糖尿病对眼部和全身功能和结构的影响。
