Skip to main content

Advertisement

Log in

Analysis of risk factors for dry eye disease and effect of diquafosol sodium ophthalmic solution on the tear film after vitrectomy in patients with type 2 diabetes mellitus: a preliminary study

  • Original Paper
  • Published:
International Ophthalmology Aims and scope Submit manuscript

Abstract

Purpose

The purpose of this study was to investigate the risk factors of DM associated dry eye syndrome (DMDES) and to explore the effect of diquafosol sodium ophthalmic solution (DQS) on patients with DMDES after vitrectomy.

Methods

Totally 107 patients (107 eyes) received vitrectomy. The data of age, gender, left/right eye, duration of DM, duration of vitrectomy, fasting blood glucose and glycosylated hemoglobin were collected and analyzed for correlation between these factors and DMDES. Postoperatively, DQS was instilled in experimental group and sodium hyaluronate was instilled in control group. The noninvasive breakup time (NIBUT), tear meniscus height (TMH), Schirmer I test (SIT), corneal fluorescence staining score (CFSS) and ocular surface disease index (OSDI) were recorded before vitrectomy and 1, 2 and 3 months after vitrectomy. All data were used for statistical comparison.

Results

Gender, duration of DM and glycosylated hemoglobin were relevant factors of DMDES (P < 0.05). At 1, 2 and 3 months postoperatively, NIBUT and TMH of experimental group were significantly higher than control group (P < 0.05). Postoperatively, CFSS of experimental group was lower than that before vitrectomy, and CFSS at 2 and 3 months after vitrectomy was significantly different between the two groups (P < 0.05). At 1, 2 and 3 months postoperatively, SIT increased in both groups, but there was no significant difference between the two groups (P > 0.05). OSDI was significantly lower in experimental group at 1, 2 and 3 months postoperatively, compared with that of the control group (P < 0.05).

Conclusion

These results suggest that gender, duration of DM and glycosylated hemoglobin are risk factors for DMDES. Postoperative instillation of DQS can improve the tear film quality in patients with DMDES after vitrectomy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Data availability

All data generated or analyzed during this study are available from the corresponding author upon reasonable request.

References

  1. International Diabetes Federation (2021) IDF Diabetes Atlas. 10th ed. International Diabetes Federation

  2. Messmer EM (2015) The pathophysiology, diagnosis, and treatment of dry eye disease. Dtsch Arztebl Int 112:71–81

    PubMed  PubMed Central  Google Scholar 

  3. Bron AJ, de Paiva CS, Chauhan SK, Bonini S, Gabison EE et al (2017) TFOS DEWS II pathophysiology report. Ocul Surf 15:438–510

    Article  PubMed  Google Scholar 

  4. Knowler WC, Fowler SE, Hamman RF, Christophi CA, Hoffman HJ et al (2009) 10-year follow-up of diabetes incidence and weight loss in the diabetes prevention program outcomes study. Lancet 374:1677–1686

    Article  PubMed  Google Scholar 

  5. Yazdani-Ibn-Taz MK, Han MM, Jonuscheit S, Collier A, Nally JE, Hagan S (2019) Patient-reported severity of dry eye and quality of life in diabetes. Clin Ophthalmol 13:217–224

    Article  PubMed  PubMed Central  Google Scholar 

  6. Yoo TK, Oh E (2019) Diabetes mellitus is associated with dry eye syndrome: a meta-analysis. Int Ophthalmol 39:2611–2620

    Article  PubMed  Google Scholar 

  7. Zhang X, Zhao L, Deng S, Sun X, Wang N (2016) Dry eye syndrome in patients with diabetes mellitus: prevalence, etiology, and clinical characteristics. J Ophthalmol 2016:8201053

    Article  PubMed  PubMed Central  Google Scholar 

  8. Tsubota K, Yokoi N, Shimazaki J, Watanabe H, Dogru M et al (2017) New perspectives on dry eye definition and diagnosis: a consensus report by the asia dry eye society. Ocul Surf 15:65–76

    Article  PubMed  Google Scholar 

  9. Yokoi N, Kato H, Kinoshita S (2014) Facilitation of tear fluid secretion by 3% diquafosol ophthalmic solution in normal human eyes. Am J Ophthalmol 157:85-92.e81

    Article  CAS  PubMed  Google Scholar 

  10. Miyake H, Kawano Y, Tanaka H, Iwata A, Imanaka T et al (2016) Tear volume estimation using a modified Schirmer test: a randomized, multicenter, double-blind trial comparing 3% diquafosol ophthalmic solution and artificial tears in dry eye patients. Clin Ophthalmol 10:879–886

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Inoue Y, Ochi S (2017) Effects of 3% diquafosol sodium ophthalmic solution on higher-order aberrations in patients diagnosed with dry eye after cataract surgery. Clin Ophthalmol 11:87–93

    Article  CAS  PubMed  Google Scholar 

  12. Yokoi N, Georgiev GA (2018) Tear film-oriented diagnosis and tear film-oriented therapy for dry eye based on tear film dynamics. Invest Ophthalmol Vis Sci 59:Des13–Des22

    Article  CAS  PubMed  Google Scholar 

  13. Wu D, Chen WQ, Li R, Wang Y (2015) Efficacy and safety of topical diquafosol ophthalmic solution for treatment of dry eye: a systematic review of randomized clinical trials. Cornea 34:644–650

    Article  PubMed  Google Scholar 

  14. Fujii GY, De Juan E, Jr., Humayun MS, Chang TS, Pieramici DJ, et al. (2002) Initial experience using the transconjunctival sutureless vitrectomy system for vitreoretinal surgery. Ophthalmology 109: 1814-1820

  15. Wolffsohn JS, Arita R, Chalmers R, Djalilian A, Dogru M et al (2017) TFOS DEWS II diagnostic methodology report. Ocul Surf 15:539–574

    Article  PubMed  Google Scholar 

  16. Sang X, Li Y, Yang L, Liu JH, Wang XR et al (2018) Lipid layer thickness and tear meniscus height measurements for the differential diagnosis of evaporative dry eye subtypes. Int J Ophthalmol 11:1496–1502

    PubMed  PubMed Central  Google Scholar 

  17. Amparo F, Wang H, Yin J, Marmalidou A, Dana R (2017) Evaluating Corneal Fluorescein Staining Using a Novel Automated Method. Invest Ophthalmol Vis Sci 58: Bio168-bio173.

  18. Asian Dry Eye Society China Branch, Ocular Surface and Tear Disease Group of Ophthalmology Professional Committee of Association of Medical Exchanges Across the Taiwan Straits, Ocular Surface and Dry Eye Group of Ophthalmologist Branch of Chinese Medical Doctor Association (2020) Consensus of Chinese dry eye experts: examination and diagnosis. Chin J Ophthalmol 56:741–747

    Google Scholar 

  19. Wang S, Jia Y, Li T, Wang A, Gao L et al (2019) Dry eye disease is more prevalent in children with diabetes than in those without diabetes. Curr Eye Res 44:1299–1305

    Article  PubMed  Google Scholar 

  20. Kaiserman I, Kaiserman N, Nakar S, Vinker S (2005) Dry eye in diabetic patients. Am J Ophthalmol 139:498–503

    Article  PubMed  Google Scholar 

  21. Peck T, Olsakovsky L, Aggarwal S (2017) Dry eye syndrome in menopause and perimenopausal age group. Journal of mid-life health 8:51–54

    Article  PubMed  PubMed Central  Google Scholar 

  22. Lane JD, Krumholz DM, Sack RA, Morris C (2006) Tear glucose dynamics in diabetes mellitus. Curr Eye Res 31:895–901

    Article  CAS  PubMed  Google Scholar 

  23. Erdur SK, Aydin R, Ozsutcu M, Olmuscelik O, Eliacik M et al (2017) The relationship between metabolic syndrome, its components, and dry eye: a cross-sectional study. Curr Eye Res 42:1115–1117

    Article  PubMed  Google Scholar 

  24. McKown RL, Wang N, Raab RW, Karnati R, Zhang Y et al (2009) Lacritin and other new proteins of the lacrimal functional unit. Exp Eye Res 88:848–858

    Article  CAS  PubMed  Google Scholar 

  25. Najafi L, Malek M, Valojerdi AE, Aghili R, Khamseh ME et al (2013) Dry eye and its correlation to diabetes microvascular complications in people with type 2 diabetes mellitus. J Diabetes Complicat 27:459–462

    Article  Google Scholar 

  26. Misra SL, Patel DV, McGhee CN, Pradhan M, Kilfoyle D et al (2014) Peripheral neuropathy and tear film dysfunction in type 1 diabetes mellitus. J Diabetes Res 2014:848659

    Article  PubMed  PubMed Central  Google Scholar 

  27. Kalteniece A, Ferdousi M, Azmi S, Marshall A, Soran H et al (2018) Keratocyte density is reduced and related to corneal nerve damage in diabetic neuropathy. Invest Ophthalmol Vis Sci 59:3584–3590

    Article  CAS  PubMed  Google Scholar 

  28. Achtsidis V, Eleftheriadou I, Kozanidou E, Voumvourakis KI, Stamboulis E et al (2014) Dry eye syndrome in subjects with diabetes and association with neuropathy. Diabetes Care 37:e210-211

    Article  PubMed  Google Scholar 

  29. Inoue K, Okugawa K, Amano S, Oshika T, Takamura E et al (2005) Blinking and superficial punctate keratopathy in patients with diabetes mellitus. Eye (Lond) 19:418–421

    Article  CAS  PubMed  Google Scholar 

  30. He J, Bazan HE (2012) Mapping the nerve architecture of diabetic human corneas. Ophthalmology 119:956–964

    Article  PubMed  Google Scholar 

  31. Gunay M, Celik G, Yildiz E, Bardak H, Koc N et al (2016) Ocular surface characteristics in diabetic children. Curr Eye Res 41:1526–1531

    Article  PubMed  Google Scholar 

  32. Dogru M, Katakami C, Inoue M (2001) Tear function and ocular surface changes in noninsulin-dependent diabetes mellitus. Ophthalmology 108:586–592

    Article  CAS  PubMed  Google Scholar 

  33. Pflugfelder SC, Stern ME (2020) Biological functions of tear film. Exp Eye Res 197:108115

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Herbaut A, Liang H, Denoyer A, Baudouin C, Labbé A (2019) Tear film analysis and evaluation of optical quality: a review of the literature. J Fr Ophtalmol 42:e21–e35

    Article  CAS  PubMed  Google Scholar 

  35. Mikalauskiene L, Grzybowski A, Zemaitiene R (2021) Ocular surface changes associated with ophthalmic surgery. J Clin Med 10(8):1642

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Lee JH, Na KS, Kim TK, Oh HY, Lee MY (2019) Effects on ocular discomfort and tear film dynamics of suturing 23-gauge pars plana vitrectomies. Arq Bras Oftalmol 82:214–219

    Article  PubMed  Google Scholar 

  37. Mani R, Shobha PS, Thilagavathi S, Prema P, Viswanathan N et al (2020) Altered mucins and aquaporins indicate dry eye outcome in patients undergoing Vitreo-retinal surgery. PLoS ONE 15:e0233517

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Sato T, Koh S, Yasukura YI, Kanai M, Noguchi Y et al (2019) Surgical factors affecting changes in ocular surface dynamics in the early postoperative period after 25-gauge vitrectomy. Eye Contact Lens 45:254–259

    Article  PubMed  Google Scholar 

  39. Moon H, Yoon JH, Hyun SH, Kim KH (2014) Short-term influence of aspirating speculum use on dry eye after cataract surgery: a prospective study. Cornea 33:373–375

    Article  PubMed  Google Scholar 

  40. Tomita Y, Lee D, Tsubota K, Negishi K, Kurihara T (2021) Updates on the current treatments for diabetic retinopathy and possibility of future oral therapy. J Clin Med 10(20):4666

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Berrocal MH, Acaba-Berrocal L (2021) Early pars plana vitrectomy for proliferative diabetic retinopathy: update and review of current literature. Curr Opin Ophthalmol 32:203–208

    Article  PubMed  Google Scholar 

  42. Finis D, Ackermann P, Pischel N, König C, Hayajneh J et al (2015) Evaluation of meibomian gland dysfunction and local distribution of meibomian gland atrophy by non-contact infrared meibography. Curr Eye Res 40:982–989

    Article  PubMed  Google Scholar 

  43. Koh S, Ikeda C, Watanabe S, Oie Y, Soma T et al (2015) Effect of non-invasive tear stability assessment on tear meniscus height. Acta Ophthalmol 93:e135-139

    Article  PubMed  Google Scholar 

  44. Ngo W, Srinivasan S, Schulze M, Jones L (2014) Repeatability of grading meibomian gland dropout using two infrared systems. Optom Vis Sci 91:658–667

    Article  PubMed  Google Scholar 

  45. von Kügelgen I (2021) Molecular pharmacology of P2Y receptor subtypes. Biochem Pharmacol 187:114361

    Article  Google Scholar 

  46. Hori Y, Kageyama T, Sakamoto A, Shiba T, Nakamura M et al (2017) Comparison of short-term effects of diquafosol and rebamipide on mucin 5AC level on the rabbit ocular surface. J Ocul Pharmacol Ther 33:493–497

    Article  CAS  PubMed  Google Scholar 

  47. Fukuoka S, Arita R (2019) Tear film lipid layer increase after diquafosol instillation in dry eye patients with meibomian gland dysfunction: a randomized clinical study. Sci Rep 9:9091

    Article  PubMed  PubMed Central  Google Scholar 

  48. Zhang Q, Zhang H, Qin G, Wu Y, Song Y et al (2022) Impact of diquafosol ophthalmic solution on tear film and dry eye symptom in type 2 diabetic dry eye: a pilot study. J Ocul Pharmacol Ther 38:133–140

    Article  CAS  PubMed  Google Scholar 

  49. Yokoi N, Sonomura Y, Kato H, Komuro A, Kinoshita S (2015) Three percent diquafosol ophthalmic solution as an additional therapy to existing artificial tears with steroids for dry-eye patients with Sjögren’s syndrome. Eye (Lond) 29:1204–1212

    Article  CAS  PubMed  Google Scholar 

  50. Utsunomiya T, Kawahara A, Hanada K, Yoshida A (2017) Effects of diquafosol ophthalmic solution on quality of life in dry eye assessed using the dry eye-related quality-of-life score questionnaire: effectiveness in patients while reading and using visual display terminals. Cornea 36:908–914

    Article  PubMed  Google Scholar 

  51. Yokoi N, Uchino M, Uchino Y, Dogru M, Kawashima M et al (2015) Importance of tear film instability in dry eye disease in office workers using visual display terminals: the Osaka study. Am J Ophthalmol 159:748–754

    Article  PubMed  Google Scholar 

  52. Byun YS, Yoo YS, Kwon JY, Joo JS, Lim SA et al (2016) Diquafosol promotes corneal epithelial healing via intracellular calcium-mediated ERK activation. Exp Eye Res 143:89–97

    Article  CAS  PubMed  Google Scholar 

  53. Park JH, Moon SH, Kang DH, Um HJ, Kang SS et al (2018) Diquafosol sodium inhibits apoptosis and inflammation of corneal epithelial cells via activation of Erk1/2 and RSK. In vitro and in vivo dry eye model. Invest Ophthalmol Vis Sci 59:5108–5115

    Article  CAS  PubMed  Google Scholar 

  54. Cui L, Li Y, Lee HS, Yang JM, Choi W et al (2018) Effect of diquafosol tetrasodium 3% on the conjunctival surface and clinical findings after cataract surgery in patients with dry eye. Int Ophthalmol 38:2021–2030

    Article  PubMed  Google Scholar 

  55. Lee JH, Song IS, Kim KL, Yoon SY (2016) Effectiveness and optical quality of topical 3.0% diquafosol versus 0.05% cyclosporine a in dry eye patients following cataract surgery. J Ophthalmol 2016:8150757

    Article  PubMed  PubMed Central  Google Scholar 

  56. Kim S, Shin J, Lee JE (2021) A randomised, prospective study of the effects of 3% diquafosol on ocular surface following cataract surgery. Sci Rep 11:9124

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  57. Baek J, Doh SH, Chung SK (2016) The effect of topical diquafosol tetrasodium 3% on dry eye after cataract surgery. Curr Eye Res 41:1281–1285

    Article  CAS  PubMed  Google Scholar 

  58. Nakamura M, Imanaka T, Sakamoto A (2012) Diquafosol ophthalmic solution for dry eye treatment. Adv Ther 29:579–589

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

The authors declare that no funds, grants, or other support was received during the preparation of this manuscript.

Author information

Authors and Affiliations

Authors

Contributions

XD took part in article writing; conducting research; data analysis; and processing; ZY involved in conducting research; reviewing article; YG involved in conducting research; analysis of data; SL took part in conducting research; analysis data; XW involved in reviewing article; YS involved in reviewing article; conducting research; MD took part in design of the work; article writing; conducting research.

Corresponding author

Correspondence to Min Du.

Ethics declarations

Conflict of interest

The authors declare that there is no conflict of interest.

Consent to participate

Written informed consent was obtained from the patients.

Ethics approval

This study was approved by the Ethics Committee of the Jinan Second People’s Hospital and followed the “Declaration of Helsinki” (Registration No. JNEYLL20200102).

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Du, X., Yang, Z., Guo, Y. et al. Analysis of risk factors for dry eye disease and effect of diquafosol sodium ophthalmic solution on the tear film after vitrectomy in patients with type 2 diabetes mellitus: a preliminary study. Int Ophthalmol 43, 1849–1859 (2023). https://doi.org/10.1007/s10792-022-02584-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10792-022-02584-z

Keywords

Navigation