Tip 2 Diabetes Mellitus’lu hastalarda oküler yüzey değişikliklerinin incelenmesi

Yıl 2023, Cilt: 16 Sayı: 3, 398 - 405, 18.12.2023

Emin Serbülent Güçlü , Ömer Özer , Emrah Mat

Öz

Amaç: Diyabetik retinopatisi olan ve olmayan tip 2 diabetes mellitus hastalarında oküler yüzey değişikliklerini saptamak, aralarındaki ilişkiyi araştırmak ve bulguları sağlıklı kontrollerle karşılaştırmaktır. Yöntem: Çalışmaya diyabetik retinopatisi olan 49 hasta (grup 1) ve diyabetes mellituslu olup diyabetik retinopatisi olmayan 49 hasta (grup 2) dahil edildi. Sonuçlar benzer yaş ve cinsiyet dağılımına sahip sağlıklı kontrollerle (grup 3) karşılaştırıldı. Bulgular: Grup 1'deki hastaların Schirmer testi sonucu 9.33±3.6 mm, gözyaşı kırılma süresi 7.27±2.24 sn, OYHİ skoru 34.11±6.7 idi ve 23 (%46.9) hastada korneal boyanma vardı. Grup 2'deki hastaların Schirmer testi sonucu 13.06±3.15 mm, gözyaşı kırılma süresi 10.6±1.95 sn, OYHİ skoru 19.08±5.5 ve 8 (%16.3) hastada korneal boyanma vardır. Grup 3'deki kişilerin Schirmer testi sonucu 21.5±4.88 mm, gözyaşı kırılma süresi 13.1±1.27 sn, OYHİ skoru 6.21±1.3’tür. Her üç gruptaki hastaların değerleri karşılaştırıldığında, Schirmer testi, gözyaşı kırılma süreleri ve OYHİ skorları istatistiksel olarak anlamlı bulundu (p<0.001, tüm parametreler için). Sonuç: Çalışmamıza göre, kuru göz hastalığı ve diyabetik retinopati bir birliktelik göstermektedir. Diyabetes mellitusa bağlı oküler tutulum yalnızca retinal patolojileri içermeyip aynı zamanda ön segment yapılarını da etkileyebilir. Dolayısıyla oküler yüzey muayenesi diyabetik göz hastalığının değerlendirilmesinin önemli bir parçası olduğu düşünülebilir.

Anahtar Kelimeler

Diabetes Mellitus, gözyaşı filmi, kuru göz, oküler yüzey

Investigation of ocular surface changes in patients with type 2 Diabetes Mellitus

Öz

Aim: To determine ocular surface changes in patients with type 2 diabetes mellitus with and without diabetic retinopathy, to investigate the relationship between them and to compare the findings with healthy controls. Method: The study included 49 patients with diabetic retinopathy (group 1) and 49 patients with diabetes mellitus without diabetic retinopathy (group 2). The results were compared with healthy controls (group 3) with similar age and gender distribution. Results: Schirmer's test result of patients in group 1 was 9.33 ± 3.6 mm, tear breakup time was 7.27±2.24 s, OSDI score was 34.11±6.7 and 23 (46.9%) patients had corneal staining. The Schirmer's test result of patients in group 2 was 13.06 ± 3.15 mm, tear breakup time was 10.6 ± 1.95 s, OSDI score was 19.08 ± 5.5 and 8 (16.3%) patients had corneal staining. The Schirmer's test result of the patients in group 3 was 21.5±4.88 mm, tear breakup time was 13.1±1.27 s, and OSDI score was 6.21±1.3. When the values of the patients in all three groups were compared, Schirmer's test, tear breakup times and OSDI scores were found to be statistically significant (p<0.001 for all parameters). Conclusion: According to our study, dry eye disease and diabetic retinopathy were associated. Ocular involvement due to diabetes mellitus may not only include retinal pathologies but also affect anterior segment structures. Therefore, ocular surface examination can be considered an essential component of the evaluation of diabetic eye disease.

Anahtar Kelimeler

Diabetes Mellitus, dry eye, ocular surface, tear film

Kaynakça

• Jin J, Chen LH, Liu XL, et al. [Tear film function in non-insulin dependent diabetics]. Zhonghua Yan Ke Za Zhi. 2003 Jan;39(1):10-3. Chinese.
• Módulo CM, Jorge AG, Dias AC, et al. Influence of insulin treatment on the lacrimal gland and ocular surface of diabetic rats. Endocrine. 2009 Aug;36(1):161-8.
• Akinci A, Cetinkaya E, Aycan Z. Dry eye syndrome in diabetic children. Eur J Ophthalmol. 2007 Nov-Dec;17(6):873-8.
• Grus FH, Sabuncuo P, Dick HB, et al. Changes in the tear proteins of diabetic patients. BMC Ophthalmol. 2002 Oct 31;2:4.
• Manaviat MR, Rashidi M, Afkhami-Ardekani M, et al. Prevalence of dry eye syndrome and diabetic retinopathy in type 2 diabetic patients. BMC Ophthalmol. 2008 Jun 2;8:10.
• Gao Y, Zhang Y, Ru YS, et al. Ocular surface changes in type II diabetic patients with proliferative diabetic retinopathy. Int J Ophthalmol. 2015 Apr 18;8(2):358-64.
• Zou X, Lu L, Xu Y, et al. Prevalence and clinical characteristics of dry eye disease in community-based type 2 diabetic patients: the Beixinjing eye study. BMC Ophthalmol. 2018 May 10;18(1):117.
• Yoo TK, Oh E. Diabetes mellitus is associated with dry eye syndrome: a meta-analysis. Int Ophthalmol. 2019 Nov;39(11):2611-2620.
• Sandra Johanna GP, Antonio LA, Andrés GS. Correlation between type 2 diabetes, dry eye and Meibomian glands dysfunction. J Optom. 2019 Oct-Dec;12(4):256-262.
• Ward MF 2nd, Le P, Donaldson JC, et al. Racial and Ethnic Differences in the Association Between Diabetes Mellitus and Dry Eye Disease. Ophthalmic Epidemiol. 2019 Oct;26(5):295-300.
• Mussi N, Haque W, Robertson DM. The Association Between Risk Factors for Metabolic Syndrome and Meibomian Gland Disease in a Dry Eye Cohort. Clin Ophthalmol. 2021 Sep 11;15:3821-3832.
• Derakhshan A, Abrishami M, Khajedaluee M, et al. Comparison between Tear Film Osmolar Concentration and Other Tear Film Function Parameters in Patients with Diabetes Mellitus. Korean J Ophthalmol. 2019 Aug;33(4):326-332.
• Zhang X, Zhao L, Deng S, et al. Dry Eye Syndrome in Patients with Diabetes Mellitus: Prevalence, Etiology, and Clinical Characteristics. J Ophthalmol. 2016;2016:8201053.
• McKown RL, Wang N, Raab RW, et al. Lacritin and other new proteins of the lacrimal functional unit. Exp Eye Res. 2009 May;88(5):848-58.