PMID- 29301512 OWN - NLM STAT- MEDLINE DCOM- 20180305 LR - 20181113 IS - 1471-2415 (Electronic) IS - 1471-2415 (Linking) VI - 18 IP - 1 DP - 2018 Jan 4 TI - Epithelial changes with corneal punctate epitheliopathy in type 2 diabetes mellitus and their correlation with time to healing. PG - 1 LID - 10.1186/s12886-017-0645-6 [doi] LID - 1 AB - BACKGROUND: To study basal epithelial cell (BEC), sub-basal nerve plexus (SBN) and Langerhans cell (LC) density in patients with type 2 diabetes mellitus (T2DM) with corneal punctate epitheliopathy (CPE) and to assess their association with time to healing of CPE. METHODS: Retrospective study of in vivo confocal microscopy (IVCM) in 160 eyes from 160 patients with T2DM diagnosed with CPE due to a single cause. Key exclusion criteria included multiple-causes for CPE or treatment with autologous serum. A total of 149 eyes from 149 gender- age- and aetiolgy-matched patients with CPE without T2DM comprised the control group. Electronic records were reviewed for demographic features, history of T2DM and aetiology of CPE. Density of BEC, SBN and LC were compared between the two groups. RESULTS: The healing time in days for CPE with different aetiologies in the T2DM and control groups were as follows: dry eye (21.56 +/- 2.41; 7.00 +/- 2.19; P = 0.001); meibomian gland dysfunction (26.42 +/- 6.04; 9.21 +/- 2.55; P = 0.001); cataract extraction (38.00 +/- 19.62; 25.83 +/- 11.49; P = 0.043); drug induced (53.19 +/- 18.83; 41.86 +/- 23.87; P = 0.018) and exposure (38.25 +/- 14.13; 29.00 +/- 13.67; P = 0.026). LC density was 38.70 +/- 9.65 cells/mm(2) in the T2DM group comparedwith 25.53 +/- 3.54 cells/mm(2) in the controls (P = 0.001). SBN density was 11.76 +/- 1.69 mm/mm(2) in the T2DM group compared with 20.92 +/- 1.43 mm/mm(2) in the controls (P = 0.001). BEC density in the T2DM group was 4982 +/- 1178 cells/mm(2) compared with 5739 +/- 394 cells/mm(2) in the control group (P = 0.018). Age and duration of T2DM had no relationship with healing time (multiple linear regression, P = 0.618; P = 0.787). The density of LC in the T2DM group showed a negative correlation with SBN density (r = 0.350; R(2) = 0.1225; P = 0.034). The density of SBN in the T2DM group showed a positive correlation with BEC density (r = 0.427; R(2) = 0.1823; P = 0.008). The density of BEC in the T2DM group showed a negative correlation with healing time (r = 0.931; R(2) = 0.8668; P = 0.001). CONCLUSIONS: Utilising IVCM, we have demonstrated increased LC and decreased SBN in patients with T2DM and CPE. Both may be related to lower BEC density and nuclei enhanced reflection. Furthermore, decreased BEC density may lead to delay in cornea epithelium healing in the T2DM group comparedwith controls. An immune-mediated response may play a role in delayed wound closure in patients with T2DM. FAU - Qu, Jing-Hao AU - Qu JH AD - Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, 100730, China. FAU - Li, Li AU - Li L AD - The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China. FAU - Tian, Lei AU - Tian L AD - Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, 100730, China. FAU - Zhang, Xiao-Yu AU - Zhang XY AD - Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, 100730, China. FAU - Thomas, Ravi AU - Thomas R AD - Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, 100730, China. AD - Queensland Eye Institute, Brisbane, Australia. AD - University of Queensland, Brisbane, Australia. FAU - Sun, Xu-Guang AU - Sun XG AD - Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, 100730, China. sunxg1955@163.com. LA - eng PT - Journal Article DEP - 20180104 PL - England TA - BMC Ophthalmol JT - BMC ophthalmology JID - 100967802 SB - IM MH - Cell Count MH - Corneal Diseases/etiology/*pathology MH - Diabetes Mellitus, Type 2/*complications MH - Disease Progression MH - Epithelium, Corneal/*pathology MH - Female MH - Humans MH - Male MH - Microscopy, Confocal/*methods MH - Middle Aged MH - Prospective Studies MH - Retrospective Studies PMC - PMC5753517 OTO - NOTNLM OT - Basal epithelial cell OT - Corneal punctate epitheliopathy OT - Langerhans cell OT - Subbasal nerve plexus OT - Type 2 diabetes mellitus COIS- ETHICS APPROVAL AND CONSENT TO PARTICIPATE: This study was performed in accordance with the Declaration of Helsinki and was approved by the Ethics Committee of the Tongren Hospital, Beijing, China, and the approval number is TRCKY-023. Informed consent was obtained from all subjects after the aims and nature of the study were explained to the participants. Parental or legal guardian consent was obtained for all participants under the age of 16. CONSENT FOR PUBLICATION: Not applicable COMPETING INTERESTS: The authors declare that they have no competing interests. PUBLISHER'S NOTE: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. EDAT- 2018/01/06 06:00 MHDA- 2018/03/06 06:00 PMCR- 2018/01/04 CRDT- 2018/01/06 06:00 PHST- 2016/10/14 00:00 [received] PHST- 2017/12/04 00:00 [accepted] PHST- 2018/01/06 06:00 [entrez] PHST- 2018/01/06 06:00 [pubmed] PHST- 2018/03/06 06:00 [medline] PHST- 2018/01/04 00:00 [pmc-release] AID - 10.1186/s12886-017-0645-6 [pii] AID - 645 [pii] AID - 10.1186/s12886-017-0645-6 [doi] PST - epublish SO - BMC Ophthalmol. 2018 Jan 4;18(1):1. doi: 10.1186/s12886-017-0645-6.