Transcript Effect of Diabetes Mellitus on Central Corneal Thickness

Effect of Diabetes Mellitus on Central
Corneal Thickness and Endothelial
Counts in Ethnic Groups in Malaysia
Angela Loo, MD; Soon Lek Yap, MD; Wan Mariny, MD;
Yu Ming Ong, MD; Visvaraja Subrayan1 M.D.;
The authors have no financial interest in
any material used in this study
Ophthalmology Department, University of Malaya
World Cornea Congress VI, Boston
2010
Purpose

To investigate the effect of Type 2 DM on
endothelial cell count and central corneal
thickness among Chinese, Malay and Indian
patients in Malaysia
World Cornea Congress VI, Boston
2010
Methods

Hospital based, cross sectional study.

Screening was done daily to look for patients with Type II
Diabetes Mellitus, age > 21 years, without any previous ocular or
surgical history.

Data collection was by patient interview, ocular examination, and
blood samples for analysis of diabetic control.

Controls were randomly selected.
World Cornea Congress VI, Boston
2010
Methods

Examination of the fundus was performed at the slit lamp using
an indirect 90D or 78D lens and retinopathy status was based on
the Early Treatment Diabetic Retinopathy Study (EDTRS)

Specular microscopy was performed using the non-contact
TOPCON SP 3000 P microscope

Five central endothelial photographs of each eye were obtained
on both eyes of all patients and the mean numbers of
endothelial cell density was used for statistical analysis.
World Cornea Congress VI, Boston
2010
Results

An equal amount of the number of patients of
different races and gender were included in the study
Characteristics
Number of Patients
Diabetics (Total=434)
Non diabetics
(Total =315)
Malay
168 (38%)
102 (32%)
Chinese
129 (30%)
102 (32%)
Indian
137 (32%)
111 (36%)
Male
247(57%)
165(47%)
Female
187(43%)
149(53%)
p Value
Ethnics
0.203*
Gender
World Cornea Congress VI, Boston
2010
0.134*
Results
Comparison of central corneal thickness, CV of endothelial cell size, percentage of
hexagonal cells and corneal endothelial cell density between diabetics and non diabetics
Corneal
structure
Diabetes
mellitus
Mean
Standard
deviation
Central
corneal
thickness
Yes
0.520
No
95 % confidence
interval
Lower
bound
Upper
bound
0.032
0.517
0.523
0.510
0.032
0.506
0.513
Yes
47.90
9.76
46.98
48.83
No
48.88
9.94
47.78
49.98
% of
Hexagonal
cells
Yes
42.33
8.17
47.78
49.98
No
42.45
6.73
41.71
43.20
Endothelial
cell density
Yes
2842.0
221.7
2889.8
2995.2
No
2895.4
240.7
2839.4
2951.0
CV
World Cornea Congress VI, Boston
2010
P value
<0.001*
0.180
0.895
0.223
Results
Mean Central Corneal Thickness among
3 Ethnic Groups in Diabetics and Non Diabetics
95 % confidence interval
Mean
CCT
Standard
deviation
Lower
bound
Upper bound
Malay
0.519
0.033
0.514
0.524
Chinese
0.527
0.034
0.523
0.533
Indian
0.514
0.031
0.509
0.519
Malay
0.508
0.033
0.501
0.514
Chinese
0.516
0.027
0.511
0.521
Indian
0.507
0.033
0.5
0.513
Ethnics
Diabetic
group
Non
diabetic
group
World Cornea Congress VI, Boston
2010
p Value
0.003*
0.072*
Results
Mean Endothelial Cell Count among 3 Ethnic Groups
in Diabetics and Non Diabetics
Diabetic
group
Non
diabetic
group
Ethnics
Mean
Standard
deviation
Malay
2920.8
Chinese
95 % confidence interval
Lower bound
Upper bound
234.5
2828.8
3012.9
2960.0
206.4
2860.9
3060.1
Indian
2952.2
223.2
2870.4
3034.1
Malay
2921.4
245.8
2791.4
3011.4
Chinese
2866.1
240.2
2757.7
2894.4
Indian
2953.0
235.4
2847.1
3058.9
World Cornea Congress VI, Boston
2010
p Value
0.808
0.183
Conclusion

Significant difference in central corneal thickness among Malay,
Chinese and Indian in which Chinese has the thickest central
corneal thickness followed by Malay and Indian. However, there
was no significant difference in endothelial cell density among
the three ethnic groups.

Central corneal thickness in diabetics was significantly thicker
compared to non diabetics.

Knowledge of ethnic differences will help ophthalmologists
manage their patients better, with respect to the prevention of
complications related to ocular surgery.
World Cornea Congress VI, Boston
2010
References

Rajesh P, K.N.Ranganath, P Suresh et al. Corneal endothelium count and thickness in
diabetes mellitus. Int J Diab Ctries. 2006;26:24-26.

Mamoru Matsuda, Richard W, Henry F et al. Comparison of corneal endothelium in
an American and a Japanese population. 1985;103:68-70.

Kenji Inoue, Satoshi Kato, Yuji Inoue et al. The corneal endothelium and thickness in
type 11 diabetes mellitus. Jpn J Ophthalmology 2002;46:65-69.

Daniel H, Tien Y. Wong, Wan LW et al. Diabetes, hyperglycaemia and central corneal
thickness: The Singapore Malay eye study. Ophthalmology 2008;115:964-968
World Cornea Congress VI, Boston
2010