Corrigendum: Dry eye disease severity and impact on quality of life in type II diabetes mellitus.

[This corrects the article DOI: 10.3389/fmed.2023.1103400.].

Dry eye disease severity and impact on quality of life in type II diabetes mellitus.

Aim: To assess the severity of dry eye disease (DED) in humans, its impact on quality of life (QoL) and to grade the damage incurred by the anterior ocular surface in patients diagnosed with type 2 diabetes mellitus (T2DM). Patients and methods: Forty-six patients (mean age ± SD = 63.8 ± 6.7 years) diagnosed with T2DM were enrolled in the experimental group and 26 healthy individuals constituted the control group (67.9 ± 8.9 years). The diagnosis and gradation of DED were conducted in accordance with the International Task Force severity grading scheme. Disease-specific questionnaires were used to obtain the Ocular Surface Disease Index (OSDI) and assess the negative effects of the disease on the patient's QoL. The severity of conjunctival redness and corneal/conjunctival staining was assessed by Efron and Oxford scales, respectively. Results: According to OSDI scores, the entire experimental group presented symptoms of DED: 54.4% were diagnosed with mild DED and 46.6% with moderately severe DED. No cases of severe DED were diagnosed in either the experimental or control group. In the control group, 57.7% of individuals did not have the disease. A significant difference between the experimental and control groups was recorded for both OSDI scores (p < 0.01) and health-related QoL (p < 0.01). It was observed that keratopathy influenced the mean OSDI values of patients. The mean OSDI value was 25.14 ± 3 in the experimental group diagnosed with keratopathy, 19.3 ± 3.5 in the subgroup with no indications of corneal injury (p = 0.000002), and 13.0 ± 3.0 in the control group (p < 0.000002). Based on the DEWS scheme, a grade I severity level was observed in 46% of control subjects and 33% of patients diagnosed with T2DM (p = 0.4915); grades II and III were detected in the bulk of the experimental group (p = 0.0051; p = 0.1707). None of the subjects in the control or experimental groups manifested grade IV severity of DED. Conclusion: In comparison to healthy adults, DED adversely impacts the QoL of type 2 DM patients, regardless of the disease's association with keratopathy.

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

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.

[Efficient Use of Corneal Grafts through Multimodal Donor Tissue Splitting]. / Effiziente Verwendung von Hornhauttransplantaten durch multimodales Spendergewebesplitting.

BACKGROUND: The reduced availability of corneal donor tissue in Ukraine requires the most effective use of the available grafts. The present work describes and evaluates a method to obtain several small diameter corneal grafts from a single donor cornea ("multimodal donor tissue splitting"). MATERIAL AND METHODS: This retrospective cohort study includes keratoplasty procedures performed at the Department of Corneal Pathology, State Institution, "The Filatov Institute of Eye Diseases and Tissue Therapy of the National Academy of Medical Sciences of Ukraine", Odessa, Ukraine. The method of graft preparation includes either lamellar dissection of the entire graft or partial lamellar dissection to obtain two lamellar and/or full-thickness grafts. Grafts were not only cut in a circular manner, but the individual shape was also adjusted to match the shape of non-circular corneal defects. RESULTS: A total of 324 keratoplasties between January 2016 and December 2017, using 270 grafts, were included. In 54 cases (including 34 emergency situations), one transplant was used for two recipients. Of these, 43 were therapeutic keratoplasties and 11 peripheral lamellar keratoplasties due to grade III - IV recurrent pterygia. In two cases, two grafts for one patient were dissected from a single donor cornea. Out of 43 patients with curative keratoplasty, visual acuity improved in 28 eyes (65.1%) or remained unchanged in 15 eyes (34.9%). Postoperative visual acuity was dependent on the initial state of the eye, the localisation, the depth and the area of the corneal defect. In eyes with peripheral corneal localisation of ulcerations, even in the presence of corneal perforation, good functional results were obtained. CONCLUSION: If two or more grafts are obtained from a single donor cornea for different kinds of keratoplasty procedures, this reduces the need for corneal graft tissue and, consequently, the cost of preservation. Especially in regions with a high shortage of donor tissue, this provides additional tissue capacities for emergency situations.

[Emergency Keratoplasty with Porcine Xenografts in Necrotizing Keratitis]. / Notfallkeratoplastik mit porcinen Xenotransplantaten bei nekrotisierender Keratitis.

Background The great shortage of donor material in Ukraine makes it necessary to find additional sources of transplant material. A possible suitable material are the porcine corneas, as they are similar in structure and biomechanical parameters to the human cornea. The purpose of our study was to analyze the results of therapeutic keratoplasty (KP) with keratoxenotransplants from cryolyophilized porcine corneas in patients with severe necrotizing keratitis. Methods A retrospective analysis of 32 xenotransplantations patients with severe necrotizing keratitis (17 lamellar, 6 stepped perforating, 4 perforating, 5 "biological coverage" according to Puchkovskaya) was completed. Results All eyes could be preserved, but the graft was rejected in all eyes. A semitransparent xenograft (XG) was achieved in 9 patients (33.3%). The best results were obtained after lamellar XKP with an XT diameter of 3.5 - 6.5 mm. Lamellar XTs with larger diameters (7.0 - 10.0 mm) were opaque. Postoperatively, the intensity of the inflammatory response after stepped XKP was slightly lower than that of the classical perforating XKP. A new KP with human corneas had to be performed in 5 patients, in one case combined with an antiglaucomatous operation and in another case with cataract extraction. Antiglaucomatous surgery had to be performed in 5 patients (15.6%). Conclusion In the absence of human donor corneas, a porcine keratoxenoimplant can be used as temporary therapeutic keratoplasty in case of emergency stop the inflammation process and to save the eye. In cases of keratoxenoimplant, a poor visual outcome is expected.