Cytological conjunctival changes in patients with type 2 diabetes-associated dry eye in the presence of treatment with a combination of trehalose plus sodium hyaluronate

Authors

  • T.M. Zhmud National Pirogov Memorial Medical University, Vinnytsia https://orcid.org/0000-0002-9306-8674
  • G.I. Drozhzhyna SI "The Filatov Institute of Eye Diseases and Tissue Therapy of the NAMS of Ukraine"

DOI:

https://doi.org/10.31288/oftalmolzh2024337

Keywords:

trehalose, T2DM, dry eye disease, impression cytology, inflammatory infiltration, ocular surface, cornea

Abstract

Purpose: To assess cytological conjunctival changes in patients with type 2 diabetes mellitus (T2DM)-associated dry eye disease in the presence of treatment with a combination of trehalose and sodium hyaluronate.

Material and Methods: This study was conducted at the Pirogov Vinnytsia Regional Clinical Hospital, the clinical site of the National Pirogov Memorial Medical University, from April to December 2023. We used prospective data of 46 patients (92 eyes; mean age, 62.47 ± 6.24 years).

Results: Most patients (67%) showed abnormal conjunctival impression cytology (CIC) changes (Nelson’s grade 2 and 3) before treatment.  Among these, grade 3 squamous metaplasia was twice as common as grade 2 squamous metaplasia; this demonstrated apparent CIC changes in the group of patients, and a substantial prevalence of squamous metaplasia in type 2 diabetics. After treatment with a combination of trehalose 3% plus sodium hyaluronate 0.15%, neutrophil infiltration was observed only in 5 (11%) patients (р = 0.0375), which may indicate an anti-inflammatory effect of the combination.

Conclusion: We found a significant effect of a combination of trehalose 3% plus sodium hyaluronate 0.15% on the state of the ocular surface, with the resolution of inflammatory conjunctival infiltration, in patients with T2DM (p = 0.0375). Because stabilization or slowing of damage to epithelial cells is important for patients with T2DM and was observed in the presence of treatment with the combination eye drop, these patients require long-term treatment with the medication.

Author Biographies

T.M. Zhmud, National Pirogov Memorial Medical University, Vinnytsia

Cand Sc (Med), and Assistant Professor, Eye Disease Department, National Pirogov Memorial Medical University, Vinnytsia

G.I. Drozhzhyna, SI "The Filatov Institute of Eye Diseases and Tissue Therapy of the NAMS of Ukraine"

Dr Sc (Med), Professor, and Chief, Corneal Pathology Department, SI “The Filatov Institute of Eye Diseases and Tissue Therapy of the National Academy of Medical Sciences of Ukraine”

References

Gipson IK. The ocular surface: the challenge to enable and protect vision: the Friedenwald lecture. Invest Ophthalmol Vis Sci. 2007 Oct;48(10):4390; 4391-8. https://doi.org/10.1167/iovs.07-0770

Swamynathan SK, Wells A. Conjunctival goblet cells: Ocular surface functions, disorders that affect them, and the potential for their regeneration. Ocul Surf. 2020 Jan;18(1):19-26. https://doi.org/10.1016/j.jtos.2019.11.005

Aragona P, Giannaccare G, Mencucci R, Rubino P, Cantera E, Finocchiaro CY, et al. The Management of Dry Eye Disease: Proceedings of Italian Dry Eye Consensus Group Using the Delphi Method. J Clin Med. 2022 Oct 30;11(21):6437. https://doi.org/10.3390/jcm11216437

Barabino S, Aragona P, di Zazzo A, Rolando M; with the contribution of selected ocular surface experts from the SocietàItaliana di Dacriologia e SuperficieOculare. Updated definition and classification of dry eye disease: Renewed proposals using the nominal group and Delphi techniques. Eur J Ophthalmol. 2021 Jan;31(1):42-48. https://doi.org/10.1177/1120672120960586

Argüeso P, Balaram M, Spurr-Michaud S, Keutmann HT, Dana MR, Gipson IK. Decreased levels of the goblet cell mucin MUC5AC in tears of patients with Sjögren syndrome. Invest Ophthalmol Vis Sci. 2002 Apr;43(4):1004-11.

Shimazaki-Den S, Dogru M, Higa K, Shimazaki J. Symptoms, visual function, and mucin expression of eyes with tear film instability. Cornea. 2013 Sep;32(9):1211-8. https://doi.org/10.1097/ICO.0b013e318295a2a5

Naik K, Magdum R, Ahuja A, Kaul S, Johnson S, Mishra A, et al. Ocular Surface Diseases in Patients With Diabetes. Cureus. 2022;14(3):e23401. https://doi.org/10.7759/cureus.23401

Alves M de C, Carvalheira JB, Módulo CM, Rocha EM. Tear film and ocular surface changes in diabetes mellitus. Arq Bras Oftalmol. 2008, 71:96-103. https://doi.org/10.1590/S0004-27492008000700018

Han SB, Yang HK, Hyon JY. Influence of diabetes mellitus on anterior segment of the eye. Clin Interv Aging. 2019;14:53-63. https://doi.org/10.2147/CIA.S190713

Zhmud TM, Drozhzhyna GI, Demchuk AV (2021) Journal of ophthalmology (Ukraine) cytological features of the bulbar conjunctiva in patients with type 2 diabetes. J Ophthalmology (Ukraine). 498:24-31. https://doi.org/10.31288/oftalmolzh202112431

Cagini C, Torroni G, Mariniello M, DiLascio G, Martone G, Balestrazzi A. Trehalose/sodium hyaluronate eye drops in post-cataract ocular surface disorders. Int Ophthalmol. 2021; 41(9): 3065-3071. https://doi.org/10.1007/s10792-021-01869-z

Fariselli C, Giannaccare G, Fresina M, Versura P. Trehalose/hyaluronate eye drop effects on ocular surface inflammatory markers and mucin expression in dry eye patients. Clin Ophthalmol. 2018; 12: 1293-1300. https://doi.org/10.2147/OPTH.S174290

Zhmud T, Drozhzhyna G, Malachkova N. Evaluation and comparison of subjective and objective anterior ocular surface damage in patients with type 2 diabetes mellitus and dry eye disease. Graefes Arch Clin Exp Ophthalmol. 2023;261(2):447-52. https://doi.org/10.1007/s00417-022-05806-3

Craig JP, Nichols KK, Akpek EK, Caffery B, Dua HS, Joo CK, et al. TFOS DEWS II Definition and Classification Report. Ocul Surf. 2017 Jul;15(3):276-283. https://doi.org/10.1016/j.jtos.2017.05.008

Bron AJ, Evans VE, Smith JA. Grading of corneal and conjunctival staining in the context of other dry eye tests. Cornea. 2003; 22(7):640-650. https://doi.org/10.1097/00003226-200310000-00008

Chen A, Gibney PA. Dietary Trehalose as a Bioactive Nutrient. Nutrients. 2023;15(6):1393. https://doi.org/10.3390/nu15061393

Cejková J, Cejka C, Luyckx J. Trehalose treatment accelerates the healing of UVB-irradiated corneas. Comparative immunohistochemical studies on corneal cryostat sections and corneal impression cytology. Histol Histopathol. 2012 Aug;27(8):1029-40. doi: 10.14670/HH-27.1029.

Doan S, Bremond-Gignac D, Chiambaretta F. Comparison of the effect of a hyaluronate-trehalose solution to hyaluronate alone on Ocular Surface Disease Index in patients with moderate to severe dry eye disease. Curr Med Res Opin. 2018 Aug;34(8):1373-1376. https://doi.org/10.1080/03007995.2018.1434496

Published

2024-07-02

How to Cite

1.
Zhmud T, Drozhzhyna G. Cytological conjunctival changes in patients with type 2 diabetes-associated dry eye in the presence of treatment with a combination of trehalose plus sodium hyaluronate. J.ophthalmol. (Ukraine) [Internet]. 2024 Jul. 2 [cited 2024 Nov. 21];(3):3-7. Available from: https://ua.ozhurnal.com/index.php/files/article/view/145

Issue

Section

Clinical Ophthalmology