J Korean Ophthalmol Soc.  2014 Oct;55(10):1426-1431. 10.3341/jkos.2014.55.10.1426.

Changes in Central Corneal Thickness and Corneal Endothelial Morphology in Contact Lens-Wearing Diabetic Patients

• Kang JW
• Shin KC

• KMID: 2216859
• DOI: http://doi.org/10.3341/jkos.2014.55.10.1426

Abstract

PURPOSE
To evaluate the changes in central corneal thickness and corneal endothelium in contact lens-wearing diabetic patients.
METHODS
This study included 113 patients who visited the Department of Ophthalmology, Konkuk University Medical Center from August 2006 to August 2007. Ultrasound pachymetry and noncontact specular microscopy were performed on the right eyes of 26 diabetic patients who regularly wore soft contact lenses (group 1), 27 diabetic patients who did not wear soft contact lenses (group 2), 30 soft contact lens-wearers without diabetes mellitus (DM) (group 3), and 30 normal subjects who did not wear soft contact lenses (group 4). Central corneal thickness, corneal endothelial cell density, endothelial cell coefficient of variation, and percentage of hexagonal endothelial cells were compared between the groups.
RESULTS
Average duration of diabetes in groups 1 and 2 was 4.38 and 4.41 years, respectively, and average duration of soft contact lens wear in groups 1 and 3 was 5.27 and 3.65 years, respectively. The central cornea was significantly thicker and the endothelial cell density was significantly lower in group 1 than in groups 3 and 4. The cell size coefficient of variation was higher in group 1 than in groups 2 and 4 and higher in group 3 than in group 4. The percentage of hexagonal cells was significantly lower in group 3 than in group 4.
CONCLUSIONS
Central corneal thickness and endothelial cell density are more affected by DM than contact lens use, and corneal endothelial cell morphology is influenced more by contact lens use than DM. Contact lens use in diabetic patients significantly influences all characteristics of the corneal endothelium compared with those in normal subjects. Patients with DM should be advised not to wear contact lenses.

Keyword

Contact lens; Corneal endothelial cell; Corneal thickness; Diabetes mellitus

MeSH Terms

Academic Medical Centers
Cell Size
Contact Lenses
Contact Lenses, Hydrophilic
Cornea
Diabetes Mellitus
Endothelial Cells
Endothelium, Corneal
Humans
Microscopy
Ophthalmology
Ultrasonography

Reference

References

1. Tuft SJ, Coster DJ. The corneal endothelium. Eye (Lond). 1990; 4(Pt 3):389–424.

2. Wilson RS, Roper-Hall MJ. Effect of age on the endothelial cell count in the normal eye. Br J Ophthalmol. 1982; 66:513–5.

3. Hoffer KJ, Kraff MC. Normal endothelial cell count range. Ophthalmology. 1980; 87:861–6.

4. Faragher RG, Mulholland B, Tuft SJ, et al. Aging and the cornea. Br J Ophthalmol. 1997; 81:814–7.

5. Blatt HL, Rao GN, Aquavella JV. Endothelial cell density in relation to morphology. Invest Ophthalmol Vis Sci. 1979; 18:856–9.

6. Bourne WM, Nelson LR, Hodge DO. Central corneal endothelial cell changes over a ten-year period. Invest Ophthalmol Vis Sci. 1997; 38:779–82.

7. Sheng H, Bullimore MA. Factors affecting corneal endothelial morphology. Cornea. 2007; 26:520–5.

8. Saini JS, Khandalavla B. Corneal epithelial fragility in diabetes mellitus. Can J Ophthalmol. 1995; 30:142–6.

9. McNamara NA, Brand RJ, Polse KA, Bourne WM. Corneal function during normal and high serum glucose levels in diabetes. Invest Ophthalmol Vis Sci. 1998; 39:3–17.

10. Dogru M, Katakami C, Inoue M. Tear function and ocular surface changes in noninsulin-dependent diabetes mellitus. Ophthalmology. 2001; 108:586–92.

11. Rosenberg ME, Tervo TM, Immonen IJ, et al. Corneal structure and sensitivity in type 1 diabetes mellitus. Invest Ophthalmol Vis Sci. 2000; 41:2915–21.

12. Schultz RO, Van Horn DL, Peters MA, et al. Diabetic keratopathy. Trans Am Ophthalmol Soc. 1981; 79:180–99.

13. Zagon IS, Sassani JW, McLaughlin PJ. Insulin treatment ameliorates impaired corneal reepithelialization in diabetic rats. Diabetes. 2006; 55:1141–7.

14. Chikama T, Wakuta M, Liu Y, Nishida T. Deviated mechanism of wound healing in diabetic corneas. Cornea. 2007; 26(9 Suppl 1):S75–81.

15. Larsson LI, Bourne WM, Pach JM, Brubaker RF. Structure and function of the corneal endothelium in diabetes mellitus type I and type II. Arch Ophthalmol. 1996; 114:9–14.

16. Busted N, Olsen T, Schmitz O. Clinical observations on the corneal thickness and the corneal endothelium in diabetes mellitus. Br J Ophthalmol. 1981; 65:687–90.

17. Pierro L, Brancato R, Zaganelli E. Correlation of corneal thickness with blood glucose control in diabetes mellitus. Acta Ophthalmol (Copenh). 1993; 71:169–72.

18. Herse P, Hooker B. Corneal edema recovery dynamics in diabetes: is the alloxan induced diabetic rabbit a useful model? Invest Ophthalmol Vis Sci. 1994; 35:310–3.

19. Skaff A, Cullen AP, Doughty MJ, Fonn D. Corneal swelling and recovery following wear of thick hydrogel contact lenses in insulin-dependent diabetics. Ophthalmic Physiol Opt. 1995; 15:287–97.

20. Stolwijk TR, van Best JA, Oosterhuis JA, Swart W. Corneal autofluorescence: an indicator of diabetic retinopathy. Invest Ophthalmol Vis Sci. 1992; 33:92–7.

21. Ishino Y, Yokoi N, Yasuhara T, et al. Investigation of Corneal Autofluorescence in Diabetic Patients. Jpn J Ophthalmol. 2001; 45:116.

22. Gekka M, Miyata K, Nagai Y, et al. Corneal epithelial barrier function in diabetic patients. Cornea. 2004; 23:35–7.

23. Saini JS, Mittal S. In vivo assessment of corneal endothelial function in diabetes mellitus. Arch Ophthalmol. 1996; 114:649–53.

24. Quadrado MJ, Popper M, Morgado AM, et al. Diabetes and corneal cell densities in humans by in vivo confocal microscopy. Cornea. 2006; 25:761–8.

25. Roszkowska AM, Tringali CG, Colosi P, et al. Corneal endothelium evaluation in type I and type II diabetes mellitus. Ophthalmologica. 1999; 213:258–61.

26. Sudhir RR, Raman R, Sharma T. Changes in the corneal endothelial cell density and morphology in patients with type 2 diabetes mellitus: a population-based study, Sankara Nethralaya Diabetic Retinopathy and Molecular Genetics Study (SN-DREAMS, Report 23). Cornea. 2012; 31:1119–22.

27. Choo M, Prakash K, Samsudin A, et al. Corneal changes in type II diabetes mellitus in Malaysia. Int J Ophthalmol. 2010; 3:234–6.

28. Olsen T, Busted N. Corneal thickness in eyes with diabetic and nondiabetic neovascularisation. Br J Ophthalmol. 1981; 65:691–3.

29. Lee JS, Oum BS, Choi HY, et al. Differences in corneal thickness and corneal endothelium related to duration in diabetes. Eye (Lond). 2006; 20:315–8.

30. Shenoy R, Khandekar R, Bialasiewicz A, Al Muniri A. Corneal endothelium in patients with diabetes mellitus: a historical cohort study. Eur J Ophthalmol. 2009; 19:369–75.

31. Ozdamar Y, Cankaya B, Ozalp S, et al. Is there a correlation between diabetes mellitus and central corneal thickness? J Glaucoma. 2010; 19:613–6.

32. Storr-Paulsen A, Singh A, Jeppesen H, et al. Corneal endothelial morphology and central thickness in patients with type II diabetes mellitus. Acta Ophthalmol. 2014; 92:158–60.

33. Meyer LA, Ubels JL, Edelhauser HF. Corneal endothelial morphology in the rat. Effects of aging, diabetes, and topical aldose reductase inhibitor treatment. Invest Ophthalmol Vis Sci. 1988; 29:940–8.

34. Bonanno JA. Effects of contact lens-induced hypoxia on the physiology of the corneal endothelium. Optom Vis Sci. 2001; 78:783–90.

35. Yagmur M, Okay O, Sizmaz S, et al. In vivo confocal microscopy: corneal changes of hydrogel contact lens wearers. Int Ophthalmol. 2011; 31:377–83.

36. Holden BA, Mertz GW, McNally JJ. Corneal swelling response to contact lenses worn under extended wear conditions. Invest Ophthalmol Vis Sci. 1983; 24:218–26.

37. Bergmanson JP, Chu LW. Corneal response to rigid contact lens wear. Br J Ophthalmol. 1982; 66:667–75.

38. Nieuwendaal CP, Odenthal MT, Kok JH, et al. Morphology and function of the corneal endothelium after long-term contact lens wear. Invest Ophthalmol Vis Sci. 1994; 35:3071–7.

39. Holden BA, Sweeney DF, Vannas A, et al. Effects of long-term extended contact lens wear on the human cornea. Invest Ophthalmol Vis Sci. 1985; 26:1489–501.

40. Carlson KH, Bourne WM. Endothelial morphologic features and function after long-term extended wear of contact lenses. Arch Ophthalmol. 1988; 106:1677–9.

41. Lee JS, Park WS, Lee SH, et al. A comparative study of corneal endothelial changes induced by different durations of soft contact lens wear. Graefes Arch Clin Exp Ophthalmol. 2001; 239:1–4.

42. March W, Long B, Hofmann W, et al. Safety of contact lenses in patients with diabetes. Diabetes Technol Ther. 2004; 6:49–52.

43. O'Donnell C, Efron N, Boulton AJ. A prospective study of contact lens wear in diabetes mellitus. Ophthalmic Physiol Opt. 2001; 21:127–38.

44. O'Donnell C, Efron N. Corneal endothelial cell morphometry and corneal thickness in diabetic contact lens wearers. Optom Vis Sci. 2004; 81:858–62.

45. O'Donnell C, Efron N. Corneal hydration control in contact lens wearers with diabetes mellitus. Optom Vis Sci. 2006; 83:22–6.

46. Leem HS, Lee KJ, Shin KC. Central corneal thickness and corneal endothelial cell changes caused by contact lens use in diabetic patients. Yonsei Med J. 2011; 52:322–5.

47. O'Donnell C, Efron N. Diabetes and contact lens wear. Clin Exp Optom. 2012; 95:328–37.

48. Yee RW, Matsuda M, Kern TS, et al. Corneal endothelial changes in diabetic dogs. Curr Eye Res. 1985; 4:759–66.

49. Herse PR. Corneal hydration control in normal and alloxan-induced diabetic rabbits. Invest Ophthalmol Vis Sci. 1990; 31:2205–13.

50. Kaji Y, Usui T, Oshika T, et al. Advanced glycation end products in diabetic corneas. Invest Ophthalmol Vis Sci. 2000; 41:362–8.

51. Weston BC, Bourne WM, Polse KA, Hodge DO. Corneal hydration control in diabetes mellitus. Invest Ophthalmol Vis Sci. 1995; 36:586–95.

52. Klyce SD. Stromal lactate accumulation can account for corneal oedema osmotically following epithelial hypoxia in the rabbit. J Physiol. 1981; 321:49–64.

53. Liesegang TJ. Physiologic changes of the cornea with contact lens wear. CLAO J. 2002; 28:12–27.

54. Carlson KH, Bourne WM, Brubaker RF. Effect of long-term contact lens wear on corneal endothelial cell morphology and function. Invest Ophthalmol Vis Sci. 1988; 29:185–93.

55. Nieuwendaal CP, Odenthal MT, Kok JH, et al. Morphology and function of the corneal endothelium after long-term contact lens wear. Invest Ophthalmol Vis Sci. 1994; 35:3071–7.

56. Chang SW, Hu FR, Lin LL. Effects of contact lenses on corneal endothelium - a morphological and functional study. Ophthalmologica. 2001; 215:197–203.