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. 2022 Aug 30:13:956780.
doi: 10.3389/fendo.2022.956780. eCollection 2022.

The effects of acute angle closure crisis on corneal endothelial cells in patients with type 2 diabetes mellitus

Lin Cong  1   2   3 , Xiaojing Pan  1   2   3 , Yiping Xia  4 , Yangyang Zhang  1   2   3 , Jun Cheng  1   2   3 , Yanling Dong  1   2   3
Affiliations

The effects of acute angle closure crisis on corneal endothelial cells in patients with type 2 diabetes mellitus

Lin Cong et al. Front Endocrinol (Lausanne). .

Abstract

Objective: This study investigated the effects of acute angle closure crisis (AACC) on the corneal endothelial cells in patients with type 2 diabetes mellitus (DM) to identify the factors that cause corneal endothelial cell injury.

Methods: We examined 154 patients who visited Qingdao Eye Hospital for AACC in one eye (154 eyes; 28 men and 126 women; mean age of 68 ± 8 years). We divided the participants into non-DM, DM well-control, and DM poor-control groups, with the unaffected eyes used as controls. Each participant was evaluated at the hospital while under AACC. We measured the relevant index and corneal parameters of the participants for statistical analysis.

Results: There were significant statistical differences in corneal parameters among the three groups. The decreased levels of central endothelial cell density (CD) and the percentage of hexagonal cells (6A) were statistically relevant among the groups (P<0.05). The AACC duration was correlated with CD loss rate among the groups (P<0.05). The DM duration was correlated with CD loss rate in the DM well-control group. Compared with the non-DM group, the level of 6A decreased more significantly in the DM group after AACC (P<0.05). The AACC duration in the DM well-control group was significantly shorter than in the non-DM and DM poor-control groups (P<0.001). The DM poor-control group showed significantly worse visual acuity when compared with the other groups (P<0.05).

Conclusions: DM may impact the functional status of corneal endothelial cells. AACC can worsen the corneal endothelium damage in patients with DM. Blood glucose levels and the duration of intraocular hypertension are closely related to the severity of corneal endothelial injury.

Keywords: acute angle closure crisis; cornea endothelial cells; diabetic keratopathy; intraocular hypertension; type 2 diabetes mellitus.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
The Corneal Parameters of Acute Angle Closure Crisis (AACC) Eyes and Control Eyes in Study Groups. AACC, acute angle closure crisis; DM, diabetes mellitus; CD, cell density; 6A, percentage of hexagonal cells; MAX, maxmum cell area; MIN, minimun cell area; AVE, average cell area; SD, standard deviation of average area; CV, coefficient of variation of average area; CCT, central corneal thickness. The changes of CD, 6A, MAX, MIN, AVE, SD and CCT in each group were statistically significant. CV, known as the descriptive data, was not statistically significant in non-DM group and DM poor-control group.The CD loss rate between DM well-control group and DM poor-control group was statistically significant. The 6A decline rate between non-DM group and DM poor-control group was statistically significant.
Figure 2
Figure 2
The Average Duration Time of Acute Angle Closure Crisis (AACC), Intraocular Pressure (IOP) of AACC Eyes and Correlations between the AACC Duration, Cell Density (CD) Loss Rate and Percentage of Hexagonal Cell (6A) Decline Rate. DM, diabetes mellitus. (A) The scatterplot showed the tendency of duration time of three groups, the line of each group meant the average duration. Statistically significant differences were detected between non-DM group and DM well-control group (P < 0.001), DM well-control group and DM poor-control group (P < 0.001). (B) The boxes showed the average IOP of 10-90 percentile, the line in box meant the median of IOP. Both the differences of average IOP and median of IOP were not statistically significant among three groups. (C) Line chat showed average AACC duration was correlated with CD loss rate, but not with 6A decline rate.
Figure 3
Figure 3
The Relationship between Age, Intraocular Pressure (IOP), Glycosylated Hemoglobin (HbA1c), Acute Angle Closure Crisis (AACC) Duration Time and Cell Density (CD) Loss Rate DM, diabetes mellitus. The AACC duration time was positively linearly correlated with the CD loss rate.
Figure 4
Figure 4
The Relationship between Diabetes Duration Time and Cell Density (CD) Loss Rate in Diabetes Mellitus (DM) Patients. The diabetes duration was positively linearly correlated with the CD loss rate in DM well-control group. 9 patients were excluded from the statistical analysis because they were diagnosed with DM at the time of visit.
Figure 5
Figure 5
The Best-corrected Visual Acuity (BCVA) Distribution of Acute Angle Closure Crisis (AACC) Eyes in Three Study Group DM, diabetes mellitus. Bolded values indicate statistically significant. The blindness grade of BCVA in DM poor-control patients accounted for 66.67%, which was statistically significant compared to that of the non-DM group and DM well-control group.
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