Effect of microalbuminuria on corneal endothelium in patients with diabetes without retinopathy

Abstract

Background

The aim of this study was to investigate the effect of microalbuminuria on corneal endothelium in patients with diabetes without retinopathy.

Methods

This cross‐sectional study comprised 100 patients with type 2 diabetes mellitus (DM) without diabetic retinopathy and 92 control subjects without diabetes. Forty‐five patients had microalbuminuria and 55 subjects were microalbuminuria negative. Endothelial measurements were obtained using specular microscopy. Endothelial cell density, average area, co‐efficient of variation, maximum area, minimum area, hexagonality and corneal thickness were compared between the groups on the basis of microalbuminuria, DM duration and medication, HbA_1c, body mass index, serum lipid and protein profiles, hypertension and hyperlipidaemia diagnosis.

Results

There were no significant differences in age, gender, endothelial cell density, average area, co‐efficients of variation, maximum area, minimum area, hexagonality or corneal thickness among the microalbuminuria positive, microalbuminuria negative and control groups (p > 0.05). However, microalbuminuria positive patients had lower high‐density lipoprotein levels than the microalbuminuria negative patients (p = 0.042). DM and control groups showed similar endothelial measurements (p > 0.05). Patients with a HbA_1c > 7 per cent (53 mmol/mol) had lower hexagonality value (p = 0.039) than in the subjects with a HbA_1c ≤ 7 per cent. No significant differences were found in endothelial parameters when groups were compared based on DM duration, medication and co‐morbidities.

Conclusions

Microalbuminuria positive and negative patients with DM without retinopathy seem to have similar corneal endothelial measurements with controls. However, patients with a HbA_1c > 7 per cent should be monitored for deterioration in corneal endothelial cell morphology even without diabetic retinopathy, which might be critical prior to anterior segment surgery.

Key words:

• diabetes
• endothelium
• microalbuminuria
• specular microscopy

ACKNOWLEDGEMENTS

The authors declare no conflict of interest. The preliminary data from this study was presented at the 36th Congress of the European Society of Cataract and Refractive Surgeons held between the 22–26 September 2018 in Austria as an oral presentation. This study was supported by Pamukkale University Scientific Research Projects Coordination Unit under grant number 2018KRM002‐424.