Schultz R O, Peters M A, Sobocinski K, Nassif K, Schultz K J
Trans Am Ophthalmol Soc. 1983;81:107-24.
Corneal epithelial lesions can be found in approximately one-half of asymptomatic patients with diabetes mellitus. These lesions are transient and clinically resemble the keratopathy seen in staphylococcal keratoconjunctivitis. Staphylococcal organisms, however, can be isolated in equal percentages from diabetic patients without keratopathy. Diabetic peripheral neuropathy was found to be related to the presence of diabetic keratopathy after adjusting for age with analysis of covariance. The strongest predictor of both keratopathy and corneal fluorescein staining was vibration perception threshold in the toes (P less than 0.01); and the severity of keratopathy was directly related to the degree of diminution of peripheral sensation. Other predictors of keratopathy were: reduced tear breakup time (P less than 0.03), type of diabetes (P less than 0.01), and metabolic status as indicated by c-peptide fasting (P less than 0.01). No significant relationships were found between the presence of keratopathy and tear glucose levels, endothelial cell densities, corneal thickness measurements, the presence of S epidermidis, or with duration of disease. It is our conclusion that asymptomatic epithelial lesions in the nontraumatized diabetic cornea can occur as a manifestation of generalized polyneuropathy and probably represent a specific form of corneal neuropathy.
在大约一半无症状的糖尿病患者中可发现角膜上皮病变。这些病变是短暂性的，临床上类似于葡萄球菌性角结膜炎中所见的角膜病变。然而，在没有角膜病变的糖尿病患者中，分离出葡萄球菌的比例相同。经协方差分析校正年龄后发现，糖尿病周围神经病变与糖尿病角膜病变的存在有关。角膜病变和角膜荧光素染色的最强预测指标是脚趾的振动觉阈值（P<0.01）；角膜病变的严重程度与周围感觉减退的程度直接相关。角膜病变的其他预测指标包括：泪膜破裂时间缩短（P<0.03）、糖尿病类型（P<0.01）以及空腹C肽所表明的代谢状态（P<0.01）。未发现角膜病变的存在与泪液葡萄糖水平、内皮细胞密度、角膜厚度测量、表皮葡萄球菌的存在或病程之间存在显著关系。我们的结论是，非创伤性糖尿病角膜中的无症状上皮病变可能是全身性多发性神经病变的一种表现，可能代表角膜神经病变的一种特殊形式。
