Change in Corneal Biomechanical Parameters in Diabetes Mellitus

Yeon Ggoch Park; Jin Young Rhew; Kyu Ryong Choi

doi:10.7469/JKOS.2015.56.04.567

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Park, Rhew, and Choi: Change in Corneal Biomechanical Parameters in Diabetes Mellitus

Original Article

J Korean Ophthalmol Soc 2015;56(4):567-572.

Published online: 7 September 2015

DOI: https://doi.org/10.7469/JKOS.2015.56.04.567

Change in Corneal Biomechanical Parameters in Diabetes Mellitus

Yeon Ggoch Park, MD, Jin Young Rhew, MD, Kyu Ryong Choi, MD

The Institute of Ophthalmology and Optometry, Department of Ophthalmology, Ewha Womans University School of Medicine, Seoul, Korea

￭ Address reprint requests to Kyu Ryong Choi, MD Department of Ophthalmology, Ewha Womans University Medical Center, #1071 Anyangcheon-ro, Yangcheon-gu, Seoul 158-710, Korea Tel: 82-2-2650-5153, Fax: 82-2-2654-4334 E-mail: ckrey02@ewha.ac.kr

Received 5 July 201415 October 2014 Accepted 7 March 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

초록

Purpose:

In this study, we examined the changes in corneal biomechanical parameters in patients with diabetes mellitus (DM).

Methods:

Fifty patients with DM were divided into 2 subgroups, 25 diabetic patients with glycated hemoglobin (HbA1c ≤ 7% and 25 diabetic patients with HbA1c > 7%) and compared with the eyes of 80 healthy subjects. Corneal biomechanical parameters were measured using ocular response analyzer (ORA). Differences in corneal biomechanical properties between healthy subjects and diabetic patients were compared. Additionally, differences in corneal biomechanical properties between diabetic patients with HbA1c ≤ 7% and diabetic patients with HbA1c > 7% were compared.

Results:

Corneal hysteresis, corneal resistance factor and central corneal thickness (CCT) were statistically significantly higher in patients with diabetes compared to healthy subjects. Goldmann tonometer, non-contact tonometer and Goldmann-correlated intraocular pressure (IOP _g) were statistically significantly higher in patients with DM compared to healthy subjects, but corneal compensated IOP (IOP _cc) was not statistically significantly different between healthy subjects and diabetic patients. However, corneal biomechanical parameters, which were statistically significantly different between healthy subjects and DM patients, were not statistically significantly different between diabetic patients with HbA1c ≤ 7% and diabetic patients with HbA1c > 7%.

Conclusions:

Considering that corneal properties are different between diabetic patients and healthy subject, IOP _cc measured with ORA is considered clinically useful for measuring IOP as it reflects CCT and biomechanical properties that should be revised. In diabetes, changes in corneal biomechanical properties depend on long-term glucose control rather than short-term glucose control.

Keywords: Central corneal thickness, Corneal hysteresis, Diabetes mellitus, Intraocular pressure, Ocular response analyzer

References

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Table 1.

Clinical characteristics

	Control (n = 80)	Diabetic (n = 50)	p-value
Age (years)	52.57 ± 15.32	53.78 ± 15.08	0.629^*
Sex (n, %)			0.856^†
Male	41 (51)	26 (52)
Female	39 (49)	24 (48)
BCVA	0.95 ± 0.11	0.91 ± 0.17	0.117^*
Refractive error (diopter)	-0.37 ± 1.59	0.12 ± 1.80	0.191^*
HbA1c (mg/dL)	-	8.37 ± 2.99	-

Values are presented as mean ± SD unless otherwise indicated.

BCVA = best corrected visual acuity; HbA1c = glycated hemoglobin.

^* Based on t-test;

^† Based on Chi-square test.

Table 2.

Ocular characteristics of the study participants

	Healthy control		Diabetic		p-value^*
	Mean ± SD	Range	Mean ± SD	Range	p-value^*
AL (mm)	23.84 ± 0.89	22.17-25.43	23.49 ± 0.87	22.15-25.56	0.065
CCT (μ m)	542.84 ± 31.82	470-599	559.72 ± 31.98	498-638	0.005
CH (mm Hg)	9.82 ± 1.23	6.9-12.0	10.49 ± 1.62	6.6-14.2	0.009
CRF (mm Hg)	9.65 ± 1.46	5.2-12.2	10.66 ± 1.30	8.2-13.3	0.000
IOP (mm Hg)	13.25 ± 2.69	8-19	14.63 ± 2.50	9-19	0.013
IOP GAT (mm Hg)	11.83 ± 2.57	7-18	13.05 ± 2.26	9-18	0.018
IOP _g (mm Hg)	14.59 ± 3.21	7.1-24.8	16.24 ± 3.44	9.5-25.4	0.008
IOP _cc (mm Hg)	15.83 ± 2.99	8.8-25.8	16.37 ± 3.79	8.0-24.3	0.406

Values are presented as mean ± SD.

AL = axial length; CCT = central corneal thickness; CH = corneal hysteresis; CRF = corneal resistance factor; IOP _g = Goldmann-corrected intraocular pressure; IOP_cc = corneal-compensated intraocular pressure; IOP GAT = Goldmann applanation tonometer intraocular pressure.

^* Based on t-test.

Table 3.

Results of correlation analyses for IOP GAT in diabetic patients

	Age (years)	CCT (μ m)	CH (mm Hg)	CRF (mm Hg)
IOP GAT (mm Hg)
r	0.1	0.528	-0.1	0.358
p-value	0.533	0.0001	0.535	0.022

r : Pearson's correlation coefficient.

IOP GAT = Goldmann applanation tonometer intraocular pressure; CCT = central corneal thickness; CH = corneal hysteresis; CRF = corneal resistance factor.

Table 4.

Clinical and ocular characteristics of the diabetic patients

Parameter	Mean		p-value^*
Parameter	HbA1c ≤ 7 (n = 25)	HbA1c > 7 (n = 25)	p-value^*
HbA1c	6.67 ± 0.24	10.14 ± 3.43	-
CCT (μ m)	556.96 ± 29.5	562.33 ± 34.62	0.567
CH (mm Hg)	10.57 ± 1.75	10.41 ± 1.53	0.744
CRF (mm Hg)	10.69 ± 1.31	10.64 ± 1.32	0.898
IOP (mm Hg)	14.32 ± 2.43	14.91 ± 2.58	0.455
IOP GAT (mm Hg)	12.63 ± 2.27	13.41 ± 2.24	0.277
IOP _g (mm Hg)	15.83 ± 3.55	16.64 ± 3.36	0.423
IOP _cc (mm Hg)	15.95 ± 4.12	16.78 ± 3.49	0.461

Values are presented as mean ± SD.

HbA1c = glycated hemoglobin; CCT = central corneal thickness; CH = corneal hysteresis; CRF = corneal resistance factor; IOP _g = Goldmann-corrected intraocular pressure; IOP _cc = corneal-compensated intraocular pressure; IOP GAT = Goldmann applanation tonometer intraocular pressure.

^* Based on t-test.

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