Differences in corneal and anterior segment morphology between diabetic vs. healthy children and adolescents: a systematic review and meta-analysis

Abstract

Objective: To compare corneal and anterior segment morphology among children and adolescents with and without diabetes.

Materials and methods: PubMed, Embase and Scopus databases were systematically searched. Studies that were observational in design were considered. Included studies should have been done in young children and/or adolescents and compared relevant outcomes of interest based on the diabetic status. The outcomes of interest were related to corneal morphology, morphology of lens, as well as important characteristics of anterior segment such as depth, pupillary diameter, intra-ocular pressure and axial length. The pooled effect sizes were reported as weighted mean difference (WMD). STATA software was used for statistical analysis.

Results: The meta-analysis included 17 studies. Diabetic children had lower corneal endothelial cell density (cells/mm2) (WMD -215.7, 95% CI: -406.5, -24.9), higher central corneal thickness (µm) (WMD 12.66, 95% CI: 5.47, 19.84), higher lenticular thickness (mm) (WMD 0.25, 95% CI: 0.13, 0.36) and density (WMD 3.02, 95% CI: 2.23, 3.81) than non-diabetic children. The anterior chamber depth (mm) (WMD -0.17, 95% CI: -0.24, -0.09) and pupillary diameter (mm) (WMD -0.61, 95% CI: -1.12, -0.10) was significantly reduced in diabetic children, compared to non-diabetic children. No differences in the corneal curvature, corneal diameter, spherical equivalent, intra-ocular pressure, axial length, tear film breakup time and Schirmer test were noted among diabetic and non-diabetic children.

Conclusions: Significant structural changes in cornea and lens along with reduction in anterior chamber depth and pupillary diameter were found. These morphological changes may be indication for early and prompt management and underscore the need for more advanced ophthalmological evaluation techniques, in addition to routine examination.