Comparison of Dry Eye Findings in Diabetes Mellitus Patients with and without Diabetic Foot

Abstract

Purpose: To compare dry eye findings in diabetes mellitus patients with and without diabetic foot. Methods: Diabetes mellitus patients with and without diabetic foot were included in this controlled cross-sectional study. Tear break-up time (BUT) and Schirmer test results of each participant were noted. Ocular Surface Disease Index (OSDI) questionnaire was administered to each participant. Results: There were 48 diabetic patients in the study; half of them had diabetic foot (n=24). The patients with and without diabetic foot were similar in age and sex distribution. The median levels of BUT (4.0 [3.0 – 6.0] seconds for the right eye, 4.5 [3.0 – 6.5] seconds for the left eye in patients with diabetic foot) (4.0 [3.8 – 6.2] seconds for the right eye, 5.0 [3.8 – 5.2] second for the left eye in patients without diabetic foot) and Schirmer’s test (7.0 [5.0 – 17.0] mm for the right eye, 11.0 [6.8 – 17.0] mm for the left eye in patients with diabetic foot) (11.0 [7.0 – 15.8] mm for the right eye, 14.5 [6.5 – 18.5] mm for the left eye in patients without diabetic foot) were similar in both groups of patients. The scores of OSDI were similar in patients with diabetic foot (22.7 [13.5 – 36.2]) and without diabetic foot (28.4 [13.6 – 41.5]) (p=0.749). Conclusion: The Schirmer test, BUT test, and OSDI score were lower in patients with diabetic foot, but they were not statistically significant. In future studies, peripheral neuropathy examination and corneal confocal microscopy may be beneficial when evaluating dry eye parameters in this group of patients.

Keywords

• Diabetes mellitus
• diabetic foot
• dry eye
• Schirmer test
• tear break-up time test
• OSDI

Diyabetik Ayak Olan ve Olmayan Diabetes Mellitus Hastalarında Kuru Göz Bulgularının Karşılaştırılması

Abstract

Amaç: Diyabetik ayağı olan ve olmayan Diabetes Mellitus hastalarında kuru göz bulgularını karşılaştırmak. Yöntemler: Bu kontrollü kesitsel çalışmaya diyabetik ayağı olan ve olmayan diabetes mellitus hastaları dahil edildi. Her katılımcının gözyaşı kırılma zamanı (BUT) ve Schirmer testi sonuçları not edildi. Her katılımcıya Oküler Yüzey Hastalık İndeksi (OSDI) anketi uygulandı. Bulgular: Çalışmada 48 diyabet hastası vardı; yarısında diyabetik ayak vardı (n=24). Diyabetik ayağı olan ve olmayan hastaların yaş ve cinsiyet dağılımı benzerdi. Ortanca AMA seviyeleri (diyabetik ayaklı hastalarda sağ göz için 4,0 [3,0 – 6,0] saniye, sol göz için 4,5 [3,0 – 6,5] saniye) (sağ göz için 4,0 [3,8 – 6,2] saniye, 5,0 [ 3,8 – 5,2] saniye) ve Schirmer testi (diyabetik ayaklı hastalarda sağ göz için 7,0 [5,0 – 17,0] mm, sol göz için 11,0 [6,8 – 17,0] mm) (11,0) [7,0 – 15,8] mm, diyabetik ayak olmayan hastalarda sol göz için 14,5 [6,5 – 18,5] mm) her iki hasta grubunda benzerdi. OSDI skorları diyabetik ayaklı (22,7 [13,5 – 36,2]) ve diyabetik ayaksız (28,4 [13,6 – 41,5]) hastalarda benzerdi (p=0,749). Sonuç: Schirmer testi, BUT testi ve OSDI skoru diyabetik ayaklı hastalarda daha düşüktü ancak istatistiksel olarak anlamlı değildi. Gelecekteki çalışmalarda bu hasta grubunda kuru göz parametrelerinin değerlendirilmesinde periferik nöropati incelemesi ve korneal konfokal mikroskopi yararlı olabilir.

Keywords

• Diabetes mellitus
• diyabetik ayak
• kuru göz
• Schirmer testi
• gözyaşı kırılma zamanı testi
• OSDI

References

1. References 1) Erdoğan A, Düzgün AP, Erdoğan K, Özkan MB, Coşkun F. Efficacy of Hyperbaric Oxygen Therapy in Diabetic Foot Ulcers Based on Wagner Classification. J Foot Ankle Surg 2018;57(6):1115-1119.
2. 2)Bowling FL, Rashid ST, Boulton AJ. Preventing and treating foot complications associated with diabetes mellitus. Nat Rev Endocrinol 2015;11(10):606-16.
3. 3)Tavakoli M, Kallinikos PA, Efron N, Boulton AJ, Malik RA. Corneal sensitivity is reduced and relates to the severity of neuropathy in patients with diabetes. Diabetes Care 2007;30(7):1895-7.
4. 4)Kallinikos P, Berhanu M, O'Donnell C, Boulton AJ, Efron N, Malik RA. Corneal nerve tortuosity in diabetic patients with neuropathy. Invest Ophthalmol Vis Sci 2004;45(2):418-22.
5. 5)DeMill DL, Hussain M, Pop-Busui R, Shtein RM. Ocular surface disease in patients with diabetic peripheral neuropathy. Br J Ophthalmol 2016;100(7):924-928.
6. 6) Craig JP, Nichols KK, Akpek EK, Caffery B, Dua HS, Joo CK, et al.TFOS DEWS II Definition and Classification Report. Ocul Surf 2017;15(3):276-283.
7. 7) Manaviat MR, Rashidi M, Afkhami-Ardekani M, Shoja MR. Prevalence of dry eye syndrome and diabetic retinopathy in type 2 diabetic patients. BMC Ophthalmol 2008;8:10.
8. 8) Najafi L, Malek M, Valojerdi AE, Aghili R, Khamseh ME, Fallah AE, et al. Dry eye and its correlation to diabetes microvascular complications in people with type 2 diabetes mellitus. J Diabetes Complications 2013;27(5):459-62.

9. 9) Zhang X, Zhao L, Deng S, Sun X, Wang N. Dry Eye Syndrome in Patients with Diabetes Mellitus: Prevalence, Etiology, and Clinical Characteristics. J Ophthalmol 2016;2016:8201053.
10. 10) Alves Mde C, Carvalheira JB, Módulo CM, Rocha EM. Tear film and ocular surface changes in diabetes mellitus. Arq Bras Oftalmol 2008;71:96-103.
11. 11) Yoo TK, Oh E. Diabetes mellitus is associated with dry eye syndrome: a meta-analysis. Int Ophthalmol 2019;39(11):2611-2620.
12. 12) Achtsidis V, Eleftheriadou I, Kozanidou E, Voumvourakis KI, Stamboulis E, Theodosiadis PG, et al. Dry eye syndrome in subjects with diabetes and association with neuropathy. Diabetes Care 2014;37(10):e210-1.
13. 13) Tavakoli M, Quattrini C, Abbott C, Kallinikos P, Marshall A, Finnigan J, et al. Corneal confocal microscopy:a novel noninvasive test to diagnose and stratify the severity of human diabetic neuropathy. Diabetes Care 2010;33(8):1792-7.
14. 14) Misra SL, Patel DV, McGhee CN, Pradhan M, Kilfoyle D, Braatvedt GD, et al. Peripheral neuropathy and tear film dysfunction in type 1 diabetes mellitus. J Diabetes Res 2014; 2014:848659.
15. 15) Dogru M, Katakami C, Inoue M. Tear function and ocular surface changes in noninsulin-dependent diabetes mellitus. Ophthalmology 2001;108(3):586-92.
16. 16) Nitoda E, Kallinikos P, Pallikaris A, Moschandrea J, Amoiridis G, Ganotakis ES, et al. Correlation of diabetic retinopathy and corneal neuropathy using confocal microscopy. Curr Eye Res 2012;37(10):898-906.
17. 17) Ma A, Mak MS, Shih KC, Tsui CK, Cheung RK, Lee SH, et al. Association of long-term glycaemic control on tear break-up times and dry eye symptoms in Chinese patients with type 2 diabetes. Clin Exp Ophthalmol 2018;46:608-615.
18. 18) Messmer EM, Schmid-Tannwald C, Zapp D, Kampik A. In vivo confocal microscopy of corneal small fiber damage in diabetes mellitus. Graefes Arch Clin Exp Ophthalmol 2010;248(9):1307-12
19. 19) Petropoulos IN, Ferdousi M, Marshall A, Alam U, Ponirakis G, Azmi S, et al. The Inferior Whorl For Detecting Diabetic Peripheral Neuropathy Using Corneal Confocal Microscopy. Invest Ophthalmol Vis Sci 2015;56(4):2498-504
20. 20) Tavakoli M, Kallinikos PA, Efron N, Boulton AJ, Malik RA. Corneal sensitivity is reduced and relates to the severity of neuropathy in patients with diabetes. Diabetes Care 2007;30(7):1895-7.
21. 21) Herlyn A, Prakasam RK, Peschel S, Allgeier S, Köhler B, Winter K, et al. Corneal Subbasal Nerve Plexus Changes in Severe Diabetic Charcot Foot Deformity: A Pilot Study in Search for a DNOAP Biomarker. J Diabetes Res 2018;2018:5910639.
22. 22) Dehghani C, Russell AW, Perkins BA, Malik RA, Pritchard N, Edwards K, et al. A rapid decline in corneal small fibers and occurrence of foot ulceration and Charcot foot. J Diabetes Complications 2016;30(8):1437-1439.
23. 23) Inoue K, Okugawa K, Amano S, Oshika T, Takamura E, Egami F, et al. Blinking and superficial punctate keratopathy in patients with diabetes mellitus. Eye (Lond) 2005;19(4):418-21.
24. 24) Labetoulle M, Baudouin C, Calonge M, Merayo-Lloves J, Boboridis KG, Akova YA, et al. Role of corneal nerves in ocular surface homeostasis and disease. Acta Ophthalmol 2019;97(2):137-145.
25. 25) Zhivov A, Peschel S, Schober HC, Stachs O, Baltrusch S, Bambi MT, et al. Diabetic foot syndrome and corneal subbasal nerve plexus changes in congolese patients with type 2 diabetes. PLoS One 2015;10(3):e0119842.