| [Objective]This study aimed to analysis the differences of corneal endothelial between patients with type 2 diabetes mellitus(T2DM)and non-diabetic patients and explore the risk factors of corneal endothelial decline in patients with T2 DM,so as to provide a better evaluation of corneal endothelial function in patients with T2 DM during perioperative period.[Method]623 eyes with T2DM(T2DM group)and 1240 non-diabetic eyes(control group)that treated in Hospital from October 2019 to October 2020 were enrolled.The quantitative indexes of corneal endothelium were recorded by SP-1P non-contactable corneal endothelium microscope.With age,gender,body mass index BMI,hypertension,smoking history and drinking history were matched,1:1 propensity score matching(PSM)was used to analyze the differences of corneal endothelium between the two groups.Correlation thermography was plotted to explore the relevance between the corneal endothelial function and clinical variables in patients with T2 DM.And subgroup analysis were used to analysis the corneal endothelial function in patients with T2 DM under different conditions.Univariate and multivariate logistic analysis were taken to identify the risk factors of corneal endothelial function decline in patients with T2 DM.[Results]Both the levels of Cell density(CD)and Percentage of hexagonal cells of the cells marked(HEX)in T2 DM group were significantly lower than those in control group(both p < 0.001)before and after matching,and CD acted out in most significantly(2868.02 ± 335.71 vs 2599.43 ± 444.13;P < 0.001).Correlation thermography revealed that there were significant correlations between corneal endothelial parameters and age,hypertension,diabetic retinopathy(DR),duration of diabetes and insulin usage in T2 DM group,and the most relevant one was CD.According to the different duration of diabetes(≥ 10 years,< 10 years),grades of hypertension,stages of diabetic retinopathy and levels of glycosylated hemoglobin(>6.5%,≤ 6.5%),subgroups analysis were used and turned out to be that:(1)CD in patients with T2 DM and hypertension was significantly lower than that in patients with T2 DM but without hypertension(2668.20 ± 404.57 vs 2567.78 ± 457.46,P = 0.007),and it decreased with the increase of hypertension grade(grade I: 2627.86 ± 456.79,grade II: 2557.70 ± 450.00,grade III: 2457.05 ± 452.73,P = 0.006);(2)CD in DR group was significantly lower than non-DR group(2563.27±504.66 vs 2548.82±420.77 vs 2652.96±416.66,P =0.014),but there was no significant difference between the proliferative diabetic retinopathy(PDR)group and the non-proliferative diabetic retinopathy(NPDR)group(2563.27 ± 504.66 vs 2548.82 ± 420.77,P = 0.546).(3)Both Central corneal thickness(CCT)and CD in the duration of diabetes≥ 10 years were significantly lower(CCT:522.44±30.93 vs 528.43±34.03,p=0.026;CD:2569.36±478.63 vs 2655.73±377.54,p=0.041).However,no significant differences of corneal endothelial parameters were observed(all p>0.05).CD lower than the 5% quantile(1867.60 / mm2)in T2 DM group was defined as the low level,and logistic regression analysis identified that the age> 70 years,female,insulin usage and PDR were the independent risk factors for low level of CD.[Conclusion]There were morphological changes and decreased number of corneal endothelial cells in patients with T2 DM.The long duration of diabetes,hypertension and PDR are the related factors for the decline of corneal endothelial cells.Elder age,female,insulin use and diabetic retinopathy are the high-risk factors for low level of corneal endothelial cells.The damage of corneal endothelium caused by T2 DM is chronic and progressive,and early intervention,effective control of the blood glucose level,avoiding complications can reduce the decline of corneal endothelium to a certain extent.Patient with these high-risk factors above should be the key objects of corneal endothelial function evaluation and need more careful intraoperative endothelial protections. |
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