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Evaluation and comparison of subjective and objective anterior ocular surface damage in patients with type 2 diabetes mellitus and dry eye disease

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Abstract

Purpose

To evaluate anterior ocular surface damage in patients with type 2 diabetes mellitus and dry eye disease in comparison to non-diabetic controls based on conjunctival impression cytology, objective scales (Efron, Oxford) and OSDI, to correlate vision-related quality of life with grades of squamous metaplasia in T2DM patients suffering from DED.

Methods

All participants underwent complete ophthalmologic examination including Shirmer test, TBUT, conjunctival/corneal staining (Oxford scheme), evaluation of conjunctival redness (Efron grading scale), and conjunctival impression cytology (Nelson’s scale). The OSDI questionnaire was completed by both groups of patients to assess severity of DED and QoL.

Results

Squamous metaplasia was observed in 94% of the study group and 19.3% of controls (p = 0.0000). Based on the OSDI scores, 73.5% of patients reported mild DED and 26.5% suffered from moderate DED in the study group. The mean OSDI score for the study group with Nelson’s grade 2 was 18 ± 3.52 and 20.8 ± 4.68 for Nelson’s grade 3, respectively (p = 0.0745). Hence, no significant difference in QoL between grade 2 and grade 3 of squamous metaplasia was observed in patients of the study group.

Conclusion

Impression cytology is a reliable minimally invasive tool for an accurate evaluation of the ocular surface damage in patients with DED and type 2 diabetes mellitus. Severe squamous metaplasia (Nelson’s grade 3) was observed in 29.4% (10/34) of T2DM patients. In contrast, it was not detected in the control group (p = 0.0032). The absence of goblet cells in T2DM patients nether significantly reduces QoL nor contributes to the subjective DED severity (OSDI) due to complex pathways leading to DED. Thus, diagnosis of DED severity should not be solely based on subjective symptoms in this population.

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Data availability

Data are available from the corresponding author upon reasonable request.

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Acknowledgements

We thank Dr. S. Suchok for the assistance with statistical analysis and language editing that greatly improved the manuscript.

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Authors and Affiliations

  1. National Pirogov Memorial University, Vinnytsya, Ukraine

    Tetiana Zhmud & Nataliia Malachkova

  2. The Filatov Institute of Eye Diseases and tissue therapy of the National Academy of Medical Sciences of Ukraine, Odessa, Ukraine

    Galyna Drozhzhyna

  3. Department of Ophthalmology, National Pirogov Memorial University, Vinnytsya, Ukraine

    Tetiana Zhmud

Authors
  1. Tetiana Zhmud
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by TMZ, GID, and NVM. The first draft of the manuscript was written by TMZ and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Tetiana Zhmud.

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Ethics approval and consent to participate

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Bioethics Committee of the National Pirogov Memorial Medical University, Vinnytsya, Ukraine. Informed consent was obtained from all individual participants included in the study.

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Written informed consent for publication of the case (including imaging) was obtained from all participants.

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The authors declare no competing interests.

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Zhmud, T., Drozhzhyna, G. & Malachkova, N. Evaluation and comparison of subjective and objective anterior ocular surface damage in patients with type 2 diabetes mellitus and dry eye disease. Graefes Arch Clin Exp Ophthalmol 261, 447–452 (2023). https://doi.org/10.1007/s00417-022-05806-3

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