About the Author(s)

Juan A. Sanchis-Gimeno symbol
Giaval Research Group, Department of Anatomy and Human Embryology, University of Valencia, Valencia, Spain

Nabeela Hasrod Email symbol
Department of Optometry, Faculty of Health Sciences, University of Johannesburg, Doornfontein, South Africa

Ana M. Calvo-Maroto symbol
Department of Ophthalmology, Clinica Universidad de Navarra, Universidad de Navarra, Madrid, Spain

Shahed Nalla symbol
Giaval Research Group, Department of Anatomy and Human Embryology, University of Valencia, Valencia, Spain

Department of Human Anatomy and Physiology, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa

Alejandro Cerviño symbol
Optometry Research Group, Department of Optics, University of Valencia, Valencia, Spain


Sanchis-Gimeno JA, Hasrod N, Calvo-Maroto AM, Nalla S, Cerviño A. Effect of diabetes mellitus on quantitative corneal anatomy – A systemic review. Afr Vision Eye Health. 2022;81(1), a725. https://doi.org/10.4102/aveh.v81i1.725

Review Article

Effect of diabetes mellitus on quantitative corneal anatomy – A systemic review

Juan A. Sanchis-Gimeno, Nabeela Hasrod, Ana M. Calvo-Maroto, Shahed Nalla, Alejandro Cerviño

Received: 23 Nov. 2021; Accepted: 11 Apr. 2022; Published: 28 July 2022

Copyright: © 2022. The Author(s). Licensee: AOSIS.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Background: Corneal changes occur as a direct consequence of diabetes mellitus (DM). The central corneal thickness (CCT) is a useful parameter that provides information about the status of the metabolism of the cornea and can therefore help monitor the progression of DM.

Aim: The aim of this study was to determine the impact of DM on CCT and its correlation with diabetes duration and glycated haemoglobin (HbA1c) levels.

Methods: The systematic review was undertaken to answer: (1) What effect does DM have on CCT values? (2) What effect does DM duration have on CCT values? (3) What effect does HbA1c levels have on CCT values? The Web of Science was used to conduct a computerised search for articles of CCT values in DM.

Results: A total of 38 articles that met the criteria for inclusion were included in this systemic review. The researchers found 27 articles that observed increased CCT values in DM patients compared with control subjects. There were six studies in which increased CCT values were related to DM duration and 12 studies in which DM duration did not alter CCT values. Also, eight studies showed that CCT values increased with glycated haemoglobin levels, and 12 studies did not observe this finding.

Conclusion: Diabetes mellitus patients usually present with increased CCT values although there is no unanimity about the effect of DM duration and increased HbA1c levels (poor glycaemic control) in the CCT values of DM patients.

Keywords: diabetes mellitus; central corneal thickness; glycated haemoglobin levels; diabetes duration; systemic review; corneal endothelial pathology; pachymetry; ocular surface; corneal hydration.


Diabetes mellitus (DM) is a clinical syndrome characterised by a disorder in the metabolism of carbohydrates, lipids and proteins because of a defect in insulin secretion, insulin action or both. Hyperglycaemia, a symptom that characterises this disease, causes long-term damage of different organs, such as kidneys, eyes, nerves, heart and blood vessels.1 It is estimated that the prevalence rate of DM is around 6.4% worldwide, and there has been a drastic increase in people affected with DM over the last two decades.2

The development of DM complications is associated with disease duration and poor glycaemic control.3 Within the eye, all structures are susceptible to changes because of DM. Thus, people with DM show several characteristic corneal signs, such as epithelial fragility, recurrent erosions, reduced sensibility, altered epi- and endothelial barrier functions, and stromal oedema.4,5 All these signs are grouped under the term diabetic keratopathy that affects up to 70% of diabetic patients.6

Over the last few years, central corneal thickness (CCT) has played an important role in preoperative evaluation for refractive surgery,7 detection of corneal dystrophies and ectasias,8,9 dry eye management10 and long-term contact lens wear assessment.11,12 Central corneal thickness values depend on corneal endothelial function, and consequently, CCT is a useful parameter that provides information about the state or status of corneal metabolism, and it plays an important role in the assessment of intraocular pressure of certain ocular diseases, such as glaucoma, and of glycaemic control in DM.13,14

Several studies show a significant increase in CCT values in DM patients,3,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30 although the mechanism responsible for these changes in corneal structure and function remains to be fully understood. Some studies have found a correlation between DM duration and the increase of CCT values,17,20,25 and others have observed an increase in CCT values when glycated haemoglobin (HbA1c) levels are elevated.14,21,23 However, other studies did not find any relationship between CCT values, DM duration3,15,16,18,19,22,24,26,27,28,29,30 and HbA1c levels.3,15,16,18,19,22,24,26,27,28,29,30

The main aims of this systematic review31,32,33,34,35,36 were (1) to determine the impact of DM on CCT values, (2) to analyse the relationship between CCT values and DM duration and (3) to determine glycaemic control expressed through the HbA1c levels and its impact on the CCT of the DM patients.


This review aimed to determine the effect of DM on CCT values and its correlation with disease duration and glycaemic control. Consequently, the three study questions of this review included ‘(1) What effect does DM have on CCT values? (2) What effect does DM duration have on CCT values? (3) What effect does HbA1c levels have on CCT values?’.

Search strategy

The Web of Science (WoS) was used to conduct a computerised search of CCT values in DM. Peer-reviewed publications from 1980 to 2021 in indexed journals with a good impact factor as listed in Journal Citations Reports (JCR) were selected. The following terms were used in the search: ‘diabetes and corneal thickness’, ‘diabetes and pachymetry’, ‘diabetes and ocular surface’, ‘corneal hydration and diabetes’, and diabetes and corneal thickness disease’.

Inclusion and exclusion criteria

The inclusion criteria were the following: (1) studies published in English, (2) studies involving humans, (3) publications in indexed journals in JCR, (4) prospective studies related to DM effects on CCT values, (5) studies providing information about CCT in diabetic patients and (6) studies providing information on diabetes duration and HbA1c levels. The exclusion criteria were the following: (1) studies carried out on animals; (2) isolated clinical cases, reviews and retrospectives studies; and (3) studies on patients who underwent corneal surgery.

Data extraction and quality assessment

The following information was collected from the publications: first author, year of publication, study design, sample size, age and gender of study participants, type of DM, DM duration, HbA1c levels, CCT values, methods to determine CCT values and study quality.

The quality of selected studies was assessed according to journal article location on the JCR list of the year of publication, with the basis of higher quartile being the best quality for the article concerned. Thus, a maximum of four stars was assigned to those journal articles published on journals located in the first quartile (Q1), three stars to those published in the second quartile (Q2), two stars to those journal articles published in journals located in the third quartile (Q3) and one star to articles published in journals located in the fourth quartile (Q4) of their specialty according to the JCR list.

Ethical considerations

This study followed all ethical standards for research without direct contact with human or animal subjects.


The characteristics of the studies that met the inclusion criteria in this review are shown in Table 1. From an initial number of 493 articles found in all databases of WoS, 38 articles were included in the systematic review after the application of the inclusion and exclusion criteria.

TABLE 1: Studies included in this systematic review.

The devices used for obtaining the CCT values varied in the studies and included a Haag–Streit pachymeter, a digital pachymeter, specular microscopy, an ultrasonic pachymeter, a Scheimpflug camera, a biopachymeter, non-contact specular microscopy, non-contact corneal tomography, HR Pentacam tomography, an optical biometer, a pneumotonometer, a specular-type pachymeter and optical coherence tomography (OCT).

Based on studies included in this review, there are controversial results on increased CCT values in DM patients compared with control subjects. Twenty-eight studies observed that CCT values increased in DM patients as compared with control patients; however, 11 studies did not find this correlation (Figure 1).

FIGURE 1: Comparative table showing studies that detected an increase in central corneal thickness values in diabetes mellitus versus those that did not.

As shown in Figure 2, studies that investigated whether there were positive correlations between CCT and DM duration were listed. There were six studies in which increased CCT values were related to DM duration and 12 studies in which DM duration did not alter CCT values. Another positive correlation was observed in DM patients, eight studies showed that CCT values increased in relation to HbA1c levels; while 12 studies did not observe this correlation (Figure 3).

FIGURE 2: A comparative table showing studies that observed positive correlations between central corneal thickness values and diabetes duration versus those that did not.

FIGURE 3: A comparative table showing studies that observed a positive correlation between central corneal thickness values and HbA1c levels versus those that did not.


Several morphological, physiological and structural corneal changes have been described in people with DM.6 DM duration and poor glycaemic control are considered important risk factors for developing DM complications.3 An increase in CCT values is one of such complications; however, the results reported have been controversial.

One study whose aim was to study CCT values and corneal endothelium in DM patients was carried out by Busted et al.15 In this study, 81 Type-1 DM patients were included. The authors concluded that the increase in CCT values could be considered one of the first detectable changes in the diabetic eye caused by an increase in corneal hydration and dysfunction of endothelial activity. Significant correlations between DM duration, fasting blood glucose and CCT values were observed.

McNamara et al.14 evaluated the corneal response to oxidative stress under hyperglycaemia and euglycemia conditions in Type-1 DM patients. Blood glucose levels were pharmacologically controlled in these patients. They observed that corneal oedema in DM patients was higher than that observed in control subjects. When both conditions were analysed, they showed that corneal oedema was significantly less in the DM group during hyperglycaemia compared with that during euglycemic conditions. This finding was the first direct evidence that hyperglycaemia and glucose levels have an influence on the aqueous humour that may affect corneal hydration, because endothelial permeability is lower in diabetic patients under hyperglycaemic conditions.35

Based on the studies included in this review, three studies compared DM Type-1 and -217,18,23 and found an increase in CCT in both patient groups. Larsson et al.17 found significant differences in CCT values in Type-1 DM patients compared with their control subjects. In Type-2 DM patients, an increase in CCT values was observed with respect to their controls but was not statistically different. Significant correlation was observed between DM duration and CCT values in Type-2 DM patients but not between HbA1c levels and CCT values in either group. However, Roszkowska et al.18 found higher CCT values in Type-1 and Type-2 DM patients than their respective age-matched control subjects although CCT values were higher in Type-1 DM patients than in those in Type-2 DM patients. They hypothesised that this increase is caused by a decrease in endothelial function that implies an increase in corneal hydration and, consequently, an increase in CCT values. It is essential to underline that glycaemic control was less severe.

The third comparative study was conducted by Modis et al.23 They observed that corneas of DM patients were thicker than those from age-matched control groups. Moreover, they found a statistically significant correlation between blood glucose levels and CCT values in Type-1 DM patients but not in subjects with Type-2 DM. Morphology alterations of corneal endothelium observed in Type-1 DM patients could explain the increase in CCT values.23 This hypothesis corresponds with results obtained from previous studies.14,15,17,18,20,21,35

Several studies found an increase in CCT values in Type-1 DM patients as compared with control subjects.14,15,16,19,20,22,24,45,48,56 Oriowo et al.22 analysed CCT values in Type-1 DM patients with and without dry eye disease. They observed that DM patients without dry eye showed an average increase of 27 µm in CCT values with respect to their control subjects. Statistically significant correlations between CCT values, DM duration and HbA1c levels were not found.22 Lee et al.20 found that CCT values were correlated significantly with DM duration after monitoring for age. These results were based on the theory of corneal endothelial pump dysfunction.14 Contrastingly, some studies52,58 evaluated the effects of Type-2 DM on CCT values.21,30,50,51,52,53,58 Srećković et al.52 found that CCT was increased in the DM group compared with healthy subjects. They also observed that greater CCT values were found in DM patients with HbA1c levels > 7% and those with diabetes duration for more than 15 years. Kim and Kim58 supported these findings in their retrospective cross-sectional study. Regarding HbA1c levels and DM duration, CCT values were thicker in patients with diabetes duration beyond 10 years (particularly after 50 years) and HbA1c levels > 7% (at the age of 40 years). In studies in which DM patients were divided according to blood glucose levels, CCT values were also higher in DM patients than control subjects.21,24 Although a significant correlation between CCT and hyperglycaemia was observed in Type-2 DM patients,21 the authors speculated that the reason was because of corneal endothelial dysfunction with resulting stromal hydration and corneal swelling.14

Storr-Paulsen et al.3 divided Type-2 DM patients according to glycaemic status. And they found that CCT values were significantly higher in DM patients than control subjects, and a poor glycaemic control was associated with lower endothelial cell density (ECD). A cross-sectional analysis of the Singapore Epidemiology of Eye Diseases was conducted from 2004 to 201146 to evaluate the association between DM, random glucose and HbA1c with CCT values. Results from this study demonstrated that corneas from diabetic patients were thicker than those without DM, and increased CCT values were associated with higher random glucose and higher HbA1c levels. Ramm et al48 also found similar results in their study of 69 diabetic and 68 healthy subjects, whereby CCT was significantly increased in DM patients with poor control of their HbA1c levels (n = 23; HbA1c: > 7%; CCT: 571.1 ± 43.5 µm) than in well-controlled DM patients (n = 37; HbA1c: ≤ 7%; CCT: 551.9 ± 29.7 µm). They also found CCT to be 9.3 ± 2.6 µm higher in the DM group than in healthy subjects. Other studies, such as Calvo-Maroto et al.25 and Briggs et al.,26 divided Type-2 DM patients according to DM duration to evaluate the impact of this factor on CCT values. The first study classified patients into short-term (less than one year from the time of diagnosis) and long-term diabetic subjects (those diagnosed and treated for 10 years or more). They found that CCT values were significantly higher in long-term DM patients than short-term DM patients. Moreover, ECD was significantly lower in long-term DM patients than short-term DM patients. Thus, these results support the theory that DM duration predisposes factors in CCT and ECD alterations.25

Briggs et al.26 observed that Type-2 DM patients who had been diagnosed for > 10 years showed an increase of 15 µm in CCT values with respect to the other group, diagnosed less than 10 years before. Significant correlations between CCT values and DM duration were not found, and glycaemic control had no additional effect on CCT values.

Another study conducted by Sanchis-Gimeno et al.27 showed regions of corneal thickening in Type-2 DM patients compared with control subjects. DM patients showed the highest corneal thickening in the upper cornea (62.9%), followed by the nasal cornea (25.7%) and the temporal cornea (11.4%). They concluded that DM patients showed higher corneal thickness values in central and paracentral regions than control subjects. These results confirmed the findings obtained in previous studies.3,15,18,20,21,24,25 However, significant correlations between CCT values, HbA1c levels, and DM duration were not found.27

As mentioned previously, all ocular structures are susceptible to damage because of DM.4,5 Diabetic retinopathy (DR) is a microvascular complication that remains one of the leading causes of blindness worldwide (29). There are some studies that have studied the CCT values on different degrees of retinopathy.53,56 Thus, Wang et al.57 investigated the association between ocular parameters and DR in Chinese people with Type-2 DM. The authors showed that CCT was positively correlated with HbA1c levels; however, no significant correlation was found between CCT and DR.

Suraida et al.53 aimed to compare anterior ocular segment biometry amongst Type-2 DM patients with no DR and non-proliferative DR against control subjects. They found that the CCT mean value was significantly higher in DM patients than in their control group; however, the presence of non-proliferative DR did not affect CCT. They also found no significant correlations between HbA1c and anterior segment biometry in people with diabetes regardless of their retinopathy status.

Another complication of DM is the diabetic peripheral neuropathy that is a leading cause of lower-limb amputation and disabling neuropathic pain.59 Kumar et al.,44 in their study to evaluate the relationship between CCT and diabetic peripheral neuropathy severity, found that CCT is increased in patients with diabetic peripheral neuropathy compared with their control group (11% and 5.6% increase in CCT amongst severe and mild diabetic peripheral neuropathy, respectively), increases progressively with the severity of the disease (4.9%, increase in CCT amongst severe cases compared with mild cases). In accordance with diabetes complications, Olsen et al.16 evaluated the importance of neovascularisation in diabetic eyes, and they observed an increase in CCT values. They concluded that this characteristic effect in DM patients was not a secondary process caused by neovascularisation, which is a consequence of several factors including ischemia, which, in turn, can occur in both DM patients and control subjects. However, the type of DM and HbA1c levels were not considered in the study by Olsen et al.16 In clinical practice, accurate measurements of CCT can be useful to determine endothelial cell function; therefore these measurements must be rapid, precise and reproducible.28 Thus, a comparative study30 evaluated the agreement in CCT measures carried out by different devices (Scheimpflug Pentacam camera, non-contact specular microscopy and ultrasonic pachymetry) in Type-2 DM patients. All CCT measures were classified according to HbA1c levels and DM duration. They found higher CCT measurements in DM patients than control subjects by three devices, but the measurements were not statistically significant. Based on this analysis, the authors concluded that HbA1c levels could determine CCT measurement better than duration.30

All the studies mentioned found significant differences in CCT values in Type-1 and Type-2 DM patients compared with their respective controls. However, this systematic review also found studies in which CCT values were not statistically different between DM subjects and control subjects (Figure 1). Keoleian et al.38 studied CCT values in 14 Type-1 DM patients and controls and in 14 age-matched controls. They observed that there was no difference in CCT values between either group of subjects.

Inoue et al.39 evaluated CCT measurements in Type-2 DM patients divided according to the degree of retinopathy and control subjects. They observed that CCT values were similar in all diabetic groups, and the differences between DM patients and controls were not statistically significant. These results were supported by Sudhir et al.40

Ziadi et al.41 evaluated the control of corneal hydration in DM patients (Type-1 and Type-2) during contact lens-induced hypoxia. They observed that CCT measures were not statistically different in either the DM groups or the control subjects. Other studies did not find significant differences between people with DM and control subjects.42,43

In children, Xiao et al.55 investigated the influence of Type-1 DM on ocular biometry, and they showed that the CCT values of the healthy children were slightly higher (571.02 µm) than that of the DM children (560.29 µm); however, neither HbA1c nor DM duration was correlated with ocular biometry and CCT in the DM group. These results coincide with those of other studies such as Beato et al.47 and Wang et al.54 where control groups were found to have higher CCT values than the DM groups. In another study carried out by Jeziorny et al.45 on children with newly diagnosed Type-1 DM, higher CCT values were found at the onset of diagnosis compared with values observed after 48 h of metabolic compensation. Negative correlations were also found between CCT and CO2 (r = –0.33; p = 0.032) and CCT and pH (r = –0.26; p = 0.088) values, respectively.

Although this review included studies that measured CCT values with different devices, some of them failed to classify DM patients for common variables, such as type of DM, DM duration or HbA1c levels.


The results from this review reveal the disparity between the published studies in the scientific literature. In addition, the findings indicate the impact of poor glycaemic control and long-term diabetes on CCT values. Thus, this parameter could be included in regular examinations in diabetic patients because its progressive increase may indicate endothelial pathological changes.


Competing interests

The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article.

Authors’ contributions

J.A.S.-G. was the project leader; J.A.S.-G. and N.H. were responsible for the writing of original draft. A.M.C., S.N. and A.C. made conceptual contributions and were responsible for review and editing.

Funding information

This research work received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

Data availability

Data sharing is not applicable to this article.


The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of any affiliated agency of the authors.


  1. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2010;33(Suppl 1):S62–S69. https://doi.org/10.2337/dc10-S062
  2. Shaw JE, Sicree RA, Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract. 2010;87(1):4–14. https://doi.org/10.1016/j.diabres.2009.10.007
  3. Storr-Paulsen A, Singh A, Jeppesen H, Norregaard JC, Thulesen J. Corneal endothelial morphology and central thickness in patients with type II diabetes mellitus. Acta Ophthalmol. 2014;92(2):158–160. https://doi.org/10.1111/aos.12064
  4. Morikubo S, Takamura Y, Kubo E, Tsuzuki S, Akagi Y. Corneal changes after small-incision cataract surgery in patients with diabetes mellitus. Arch Ophthalmol. 2004;122(7):966–969. https://doi.org/10.1001/archopht.122.7.966
  5. Hugod M, Storr-Paulsen A, Norregaard JC, Nicolini J, Larsen AB, Thulesen J. Corneal endothelial cell changes associated with cataract surgery in patients with type II diabetes mellitus. Cornea. 2011;30(7):749–753. https://doi.org/10.1097/ICO.0b013e31820142d9
  6. Quadrado MJ, Popper M, Morgado AM, Murta JV, Van Best JA. Diabetes and corneal cell densities in humans by in vivo confocal microscopy. Cornea. 2006;25(7):761–768. https://doi.org/10.1097/01.ico.0000224635.49439.d1
  7. Sanchis-Gimeno JA, Herrera M, Lleo-Perez A, Alonso L, Rahhal MS, Martinez-Soriano F. Quantitative anatomical differences in central corneal thickness values determined with scanning-slit corneal topography and non-contact specular microscopy. Cornea. 2006;25(2):203–205. https://doi.org/10.1097/01.ico.0000176605.72129.2c
  8. Insler MS, Baumann JD. Corneal thinning syndromes. Ann Ophthalmol. 1986;18:74–75.
  9. Auffarth GU, Wang L, Volcker HE. Keratoconus evaluation using the orbscan topography system. J Cataract Refract Surg. 2000;26(2):222–228. https://doi.org/10.1016/S0886-3350(99)00355-7
  10. Liu Z, Pflugfelder SC. Corneal thickness is reduced in dry eye. Cornea. 1999;18(4):403–407. https://doi.org/10.1097/00003226-199907000-00002
  11. Copt RP, Thomas R, Mermoud A. Corneal thickness in ocular hypertension, primary open-angle glaucoma, and normal tension glaucoma. Arch Ophthalmol. 1999;117(1):14–16. https://doi.org/10.1001/archopht.117.1.14
  12. Shah S, Chatterjee A, Mathai M, et al. Relationship between corneal thickness and measured intraocular pressure in a general ophthalmology clinic. Ophthalmology. 1999;106(11):2154–2160. https://doi.org/10.1016/S0161-6420(99)90498-0
  13. Baudouin C. The pathology of dry eye. Surv Ophthalmol. 2001;45(Suppl 2):S211–S220. https://doi.org/10.1016/S0039-6257(00)00200-9
  14. McNamara NA, Brand RJ, Polse KA, Bourne WM. Corneal function during normal and high serum glucose levels in diabetes. Invest Ophthalmol Vis Sci. 1998;39:3–17.
  15. Busted N, Olsen T, Schmitz O. Clinical observations on the coreal thickness and the corneal endothelium in diabetes mellitus. Br J Ophthalmol. 1981;65(10):687–690. https://doi.org/10.1136/bjo.65.10.687
  16. Olsen T, Busted N, Schmitz O. Corneal thickness in diabetes mellitus. Lancet. 1980;1(8173):883. https://doi.org/10.1016/S0140-6736(80)91389-6
  17. Larsson LI, Bourne WM, Pach JM, Brubaker RF. Structure and function of the corneal endothelium in diabetes mellitus type-I and type-II. Arch Ophthalmol. 1996;114(1):9–14. https://doi.org/10.1001/archopht.1996.01100130007001
  18. Roszkowska AM, Tringali CG, Colosi P, Squeri CA, Ferreri G. Corneal endothelium evaluation in type I and type II diabetes mellitus. Ophthalmologica. 1999;213:258–261. https://doi.org/10.1159/000027431
  19. Rosenberg ME, Tervo TM, Immonen IJ, Müller LJ, Grönhagen-Riska C, Vesaluoma MH. Corneal structure and sensitivity in type-1 diabetes mellitus. Invest Ophthalmol Vis Sci. 2000;41:2915–2921.
  20. Lee JS, Oum BS, Choi HY, Lee JE, Cho BM. Differences in corneal thickness and corneal endothelium related to duration in diabetes. Eye (Lond). 2006;20:315–318. https://doi.org/10.1038/sj.eye.6701868
  21. Su DH, Wong TY, Wong WL, et al. (Singapore Malay Eye Study Group). Diabetes, hyperglycemia, and central corneal thickness: The Singapore Malay Eye Study. Ophthalmology. 2008;115(6):964–968. https://doi.org/10.1016/j.ophtha.2007.08.021
  22. Oriowo OM. Profile of central corneal thickness in diabetics with and without dry eye in a Saudi population. Optometry. 2009;80(8):442–446. https://doi.org/10.1016/j.optm.2008.12.008
  23. Módis L Jr, Szalai E, Kertész K, Kemény-Beke A, Kettesy B, Berta A. Evaluation of the corneal endothelium in patients with diabetes mellitus type I and II. Histol Histopathol. 2010;25:1531–1537.
  24. Ozdamar Y, Cankaya B, Ozalp S, Acaroglu G, Karakaya J, Ozkan SS. Is there a correlation between diabetes mellitus and central corneal thickness? J Glaucoma. 2010;19(9):613–616. https://doi.org/10.1097/IJG.0b013e3181ca7c62
  25. Calvo-Maroto AM, Cerviño A, Perez-Cambrodí RJ, García-Lázaro S, Sanchis-Gimeno JA. Quantitative corneal anatomy: Evaluation of the effect of diabetes duration on the endothelial cell density and corneal thickness. Ophthalmic Physiol Opt. 2015;35(3):293–298. https://doi.org/10.1111/opo.12191
  26. Briggs S, Osuagwu UL, AlHarthi EM. Manifestations of type-2 diabetes in corneal endothelial cell density, corneal thickness and intraocular pressure. J Biomed Res. 2015;30(1):46–51. https://doi.org/10.7555/JBR.29.20140075
  27. Sanchis-Gimeno JA, Alonso L, Rahhal M, Bastir M, Perez-Bermejo M, Belda-Salmeron L. Corneal thickness differences between type-2 diabetes and non-diabetes subjects during preoperative laser surgery examination. J Diabetes Complications. 2017;31(1):209–212. https://doi.org/10.1016/j.jdiacomp.2016.08.024
  28. Marsich MM, Bullimore MA. The repeatability of corneal thickness measures. Cornea. 2000;19(6):792–795. https://doi.org/10.1097/00003226-200011000-00007
  29. Fong DS, Aiello LP, Gardner TW, et al. Retinopathy in diabetes. Diabetes Care. 2004;27(Suppl_1):84S–87S. https://doi.org/10.2337/diacare.27.2007.S84
  30. Altay Y, Balta O, Demirok G, Burcu A, Bezen Balta O, Ornek F. Agreement between corneal thickness measurements using pentacam scheimpflug camera, noncontact specular microscopy, and ultrasonographic pachymetry in diabetic patients. Curr Eye Res. 2017;42(2):187–194. https://doi.org/10.3109/02713683.2016.1170854
  31. Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. J Clin Epidemiol. 2009;62(10):1006–1012. https://doi.org/10.1016/j.jclinepi.2009.06.005
  32. Borenstein M, Hedges L, Higgins J, Rothstein H. Comprehensive meta-analysis V2. Englewood NJ: Biostat; 2005.
  33. Begg CB, Mazumbar M. Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994;50(4):1088–1101. https://doi.org/10.2307/2533446
  34. Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. Br Med J. 1997;315:629–634. https://doi.org/10.1136/bmj.315.7109.629
  35. Weston BC, Bourne WM, Polse KA, Hodge DO. Corneal hydration control in diabetes mellitus. Invest Ophthalmol Vis Sci. 1995;36:586–595.
  36. Claramonte PJ, Ruiz-Moreno JM, Sánchez-Pérez SI, et al. Variation of central corneal thickness in diabetic patients as detected by ultrasonic pachymetry. Arch Soc Esp Oftalmol. 2006;81(9):523–526. https://doi.org/10.4321/S0365-66912006000900007
  37. Schultz RO, Matsuda M, Yee RW, Edelhauser HF, Schultz KJ. Corneal endothelial changes in type I and type II diabetes mellitus. Am J Ophthalmol. 1984;98(4):401–410. https://doi.org/10.1016/0002-9394(84)90120-X
  38. Keoleian GM, Pach JM, Hodge DO, Trocme SD, Bourne WM. Structural and functional studies of the corneal endothelium in diabetes mellitus. Am J Ophthalmol. 1992;113(1):64–70. https://doi.org/10.1016/S0002-9394(14)75755-1
  39. Inoue K, Kato S, Inoue Y, Amano S, Oshika T. The corneal endothelium and thickness in type II diabetes mellitus. Jpn J Ophthalmol. 2002;46:65–69.
  40. Sudhir RR, Raman R, Sharma T. Changes in the corneal endothelial cell density and morphology in patients with type-2 diabetes mellitus: A population based study, Sankara Nethralaya Diabetic Retinopathy and Molecular Genetics Study (SN-DREAMS, Report 23). Cornea. 2012;31(10):1119–1122. https://doi.org/10.1097/ICO.0b013e31823f8e00
  41. Ziadi M, Moiroux P, d’Athis P, Bron A, Brun JM, Creuzot-Garcher C. Assessment of induced corneal hypoxia in diabetic patients. Cornea. 2002;21(5):453–457. https://doi.org/10.1097/00003226-200207000-00004
  42. Sonmez B, Bozkurt B, Atmaca A, Irkec M, Orhan M, Aslan U. Effect of glycemic control on refractive changes in diabetic patients with hyperglycemia. Cornea. 2005;24(5):531–537. https://doi.org/10.1097/01.ico.0000151545.00489.12
  43. Wiemer NG, Dubbelman M, Kostense PJ, Ringens PJ, Polak BC. The influence of chronic diabetes mellitus on the thickness and the shape of the anterior and posterior surface of the cornea. Cornea. 2007;26(10):1165–1170. https://doi.org/10.1097/ICO.0b013e31814fa82f
  44. Kumar N, Pop-Busui R, Musch DC, et al. Central corneal thickness increase due to stromal thickening with diabetic peripheral neuropathy severity. Cornea. 2018;37(9):1138–1142. https://doi.org/10.1097/ICO.0000000000001668
  45. Jeziorny K, Niwald A, Moll A, et al. Measurement of corneal thickness, optic nerve sheath diameter and retinal nerve fiber layer as potential new non-invasive methods in assessing a risk of cerebral edema in Type-1 diabetes in children. Acta Diabetol. 2018;55:1295–1301. https://doi.org/10.1007/s00592-018-1242-8
  46. Luo XY, Dai W, Chee ML, et al. Association of diabetes with entral corneal thickness among a multiethnic asian population. JAMA Netw Open. 2019;2(1):e186647. https://doi.org/10.1001/jamanetworkopen.2018.6647
  47. Beato JN, Esteves-Leandro J, Reis D, et al. Structural and biomechanical corneal differences between type-2 diabetic and nondiabetic patients. J Ophthalmol. 2019;2019:3764878. https://doi.org/10.1155/2019/3764878
  48. Ramm L, Herber R, Spoerl E, Pillunat LE, Terai N. Intraocular pressure measurements in diabetes mellitus. Eur J Ophthalmol. 2020;30(6):1432–1439. https://doi.org/10.1177/1120672119890517
  49. Çolak S, Kazanci B, Ozçelik Soba D, Ozdamar Erol Y, Yilmazbas P. Effects of diabetes duration and HgA1C level on corneal endothelial morphology. Eur J Ophthalmol. 2020:31(3):1120672120914812. https://doi.org/10.1177/1120672120914812
  50. Hanyuda A, Sawada N, Yuki K, et al. Relationships of diabetes and hyperglycaemia with intraocular pressure in a Japanese population: The JPHC-NEXT Eye Study. Sci Rep. 2020;10:5355. https://doi.org/10.1038/s41598-020-62135-3
  51. Taşlı NG, Icel E, Karakurt Y, et al. The findings of corneal specular microscopy in patients with type-2 diabetes mellitus. BMC Ophthalmol. 2020;20:214. https://doi.org/10.1186/s12886-020-01488-9
  52. Srećković S, Todorović D, Ranđelović D, Petrović N, Stojanović J, Šarenac-Vulović T. The influence of diabetes mellitus Type-2 on the central corneal thickness. Vojnosanitetski Pregled. 2022;79(3):238–242. https://doi.org/10.2298/VSP200826101S.
  53. Suraida AR, Ibrahim M, Zunaina E. Correlation of the anterior ocular segment biometry with HbA1c level in type-2 diabetes mellitus patients. PLoS One. 2018;13(1):e0191134. https://doi.org/10.1371/journal.pone.0191134
  54. Wang S, Jia Y, Li T, et al. Comparison of corneal parameters of children with diabetes mellitus and healthy children. J Ophthalmol. 2019;2019:2037072. https://doi.org/10.1155/2019/2037072
  55. Xiao Y, Li T, Jia Y, Wang S, Yang C, Zou H. Influence of type-1 diabetes mellitus on the ocular biometry of Chinese children. J Ophthalmol. 2019;2019:7216490. https://doi.org/10.1155/2019/7216490
  56. Deák EA, Szalai E, Tóth N, Malik RA, Berta A, Csutak A. Longitudinal changes in corneal cell and nerve fiber morphology in young patients with type-1 diabetes with and without diabetic retinopathy: A 2-year follow-up study. Invest Ophthalmol Vis Sci. 2019;60:830–837. https://doi.org/10.1167/iovs.18-24516
  57. Wang L, Liu S, Wang W, et al. Association between ocular biometrical parameters and diabetic retinopathy in Chinese adults with type-2 diabetes mellitus. Acta Ophthalmol. 2020;99(5):e661–e668. https://doi.org/10.1111/aos.14671
  58. Kim YJ, Kim TG. The effects of type-2 diabetes mellitus on the corneal endothelium and central corneal thickness. Sci Rep. 2021;11:8324. https://doi.org/10.1038/s41598-021-87896-3
  59. Costa PZ, Soares R. Neovascularization in diabetes and its complications. Unraveling the angiogenic paradox. Life Sci. 2013;92(22):1037–1045. https://doi.org/10.1016/j.lfs.2013.04.001

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