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Effects of chewing tobacco on corneal endothelium in patients with diabetes mellitus

Eye volume 37, pages 3392–3397 (2023)Cite this article

Subjects

Abstract

Objective

To determine the impact of tobacco chewing on corneal endothelial structure in patients with diabetes mellitus (DM).

Methods

Corneal endothelial parameters (endothelial cell count, ECD; coefficient of variation, CV; hexagonality, Hex, and central corneal thickness, CCT) were analysed in 1234 eyes of 1234 patients using non-contact specular microscopy (EM 4000 Tomey Nishi-Ku, Nagoya, Aichi, Japan). The study group (with a present history of tobacco chewing) comprising of 948 subjects, with 473 having DM was compared with age and gender-matched control group comprising of 286 subjects (139 having DM) with no history of tobacco use in any form.

Results

Tobacco chewers had a significantly reduced ECD (P = 0.024) and Hex (P = 0.009) as compared with non-chewers. Similar results were noted in ECD (P = 0.004) and Hex (P = 0.005) in patients with DM. Tobacco chewers had a significantly decreased ECD values among males, HbA1C ≤ 7.5% and duration of DM ≤ 20 years, and significantly decreased Hex among those with >50 years of age, females, and duration of DM > 20 years. The CV and CCT values were comparable between the study and the control groups. Tobacco chewers showed a significant association of ECD with age, HbA1C, and duration of DM; CV with HbA1C; Hex with age and duration of DM; and CCT with gender, age, HbA1C and duration of DM.

Conclusions

Tobacco chewing may negatively impact corneal health, especially confounded by additional factors like age and DM. These factors must be accounted for in the pre-operative evaluation of such patients prior to any intra-ocular surgery.

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Fig. 1: Average values of study parameters in chewers versus non-chewers.

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Data availability

Data is available with the corresponding author, and can be made available upon request.

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Author information

Authors and Affiliations

  1. Department of Ophthalmology, Military Hospital Gaya, Gaya, 823005, India

    Ashok Jha

  2. Department of Ophthalmology and Visual Sciences, University of Louisville, 310 E Muhammad Ali Blvd, Louisville, 40202, Kentucky, USA

    Aditya Verma

  3. Shree Vishveshwara Netraalaya, Gaya, Gaya, 823001, Bihar, India

    Charima Priya

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  1. Ashok Jha
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  2. Aditya Verma
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  3. Charima Priya
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Contributions

AJ was responsible for designing the review protocol, writing the protocol, and report, conducting the search, screening potentially eligible studies, extracting and analysing the data, interpreting results, updating reference lists and creating ‘Summary of findings’ tables. AV was responsible for designing the review protocol and screening potentially eligible studies. He also contributed to design the paper and conduct in depth analysis. CP was instrumental conducting and designing the analysis and tables and formulate the results.

Corresponding author

Correspondence to Ashok Jha.

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Jha, A., Verma, A. & Priya, C. Effects of chewing tobacco on corneal endothelium in patients with diabetes mellitus. Eye 37, 3392–3397 (2023). https://doi.org/10.1038/s41433-023-02515-x

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