Ocular surface changes with applanation contact lens and coupling fluid use after argon laser photocoagulation in noninsulin-dependent diabetes mellitus.
OBJECTIVE
To describe the effect of coupling solutions used during laser photocoagulation on the ocular surface of patients with noninsulin-dependent diabetes mellitus (NIDDM).


METHODS
A prospective case-controlled study.


METHODS
Ninety-two eyes of 46 NIDDM patients with clinically significant macular edema, poor metabolic control of diabetes, and peripheral neuropathy and 100 eyes of 50 normal control subjects were studied. The patients' eyes were assigned to argon green focal/grid laser photocoagulation using an applanation contact lens and one of the coupling fluids; 2% methocel, Thilo-Tears Gel, 1.4% sodium hyaluronate, or 0.9% simple saline. The control subjects received time-matched three-mirror contact lens fundus examinations. All subjects underwent corneal sensitivity measurements, Schirmer test, tear film breakup time, and corneal fluorescein staining before as well as 3 and 8 days after the laser procedures and contact lens examinations. Patients with corneal problems persisting after 8 days were followed longer.


RESULTS
Diabetic eyes assigned to 2% methocel and 1.4% sodium hyaluronate had significantly lower mean corneal sensitivities and break-up time values as well as significantly higher mean fluorescein staining scores at all examination points after laser photocoagulation. All diabetic eyes with aqueous deficiency assigned to 2% methocel and 1.4% sodium hyaluronate developed delayed corneal epithelial healing.


CONCLUSIONS
The use of viscous coupling solutions during applanation contact lens-aided laser procedures may be detrimental for the corneal epithelium in poorly controlled NIDDM patients with peripheral neuropathy and coexisting aqueous deficiency.
Dogru
Murat
M
Department of Ophthalmology, Uludag University School of Medicine, Bursa, Turkey. muratodooru@yahoo.com
Kaderli
Berkant
B
Gelisken
Oner
O
Yücel
Ali
A
Avci
Remzi
R
Goto
Eiki
E
Shimmura
Shigeto
S
Shimazaki
Jun
J
Tsubota
Kazuo
K
D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D003261:Contact Lenses; D003316:Corneal Diseases / Q000139:chemically induced* / Q000378:metabolism / Q000503:physiopathology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000601:surgery*; D003930:Diabetic Retinopathy / Q000209:etiology / Q000601:surgery; D019573:Epithelium, Corneal / Q000187:drug effects / Q000378:metabolism / Q000503:physiopathology; D005260:Female; D019793:Fluorescein / Q000378:metabolism; D015590:Fluorophotometry; D006801:Humans; D006820:Hyaluronic Acid / Q000009:adverse effects*; D017075:Laser Coagulation; D008269:Macular Edema / Q000209:etiology / Q000601:surgery; D008297:Male; D008747:Methylcellulose / Q000009:adverse effects*; D008875:Middle Aged; D009883:Ophthalmic Solutions / Q000009:adverse effects; D011446:Prospective Studies; D013666:Tears / Q000502:physiology; D014945:Wound Healing / Q000187:drug effects
D009883:Ophthalmic Solutions; D006820:Hyaluronic Acid; D008747:Methylcellulose; D019793:Fluorescein