Patients with diabetes can develop problems with their eyes, like ulcers that are difficult to heal. Amniotic membrane creates a healing environment, and this article will explore how.
Diabetes symptoms and the eye
Diabetes is a growing problem, with the incidence of diabetes rising from 108 million in 1980 to 422 million worldwide in 2014. In 2015, diabetes was present in 9.4% of the US population.
Diabetes symptoms affect many systems in the body, and the eyes are no exception. Approximately 50% of patients with diabetes experience diabetic neuropathy, a progressive loss of nerve fibers. Neuropathy can exist in the eyes and, unchecked, lead to serious vision loss and even blindness. Elevated blood glucose and glycation can cause endothelial cell loss and ischemia. Hyperglycemia in patients with diabetes can cause impaired corneal sensitivity, reduced nerve fiber density, and delayed epithelial wound healing.
The corneal epithelium is a layer of tissue that protects the ocular surface from bacteria and other foreign materials and an excess of tears. Diabetes causes a lack of sensation in the eye and therefore there is less tear secretion and patients tend to blink less, causing tears to evaporate more quickly. These changes will then put patients with diabetes at a risk of developing symptoms of dry eyes. Diabetes can also cause tear-film dysfunction. Kesarwani et al. recently studied tear film dysfunction in diabetes in the Indian population. They found decreased tear secretion and stability, evidence of keratoepitheliopathy. A prolonged healing time in the eye can be a symptom of diabetes; a loss of corneal nerves leads to prolonged healing time.
Assessing corneal risks in diabetic neuropathy
A threat to the eyes of a diabetic patient can be detected early on, and it is important to catch it so that vision is not impacted. Doctors can use in vivo confocal microscopy (IVCM). Proinflammatory growth factors are released. Cytokines, chemokines, and adhesion molecules are more present the more severe the disease. The appearance of neuronal damage in early stages of diabetes has been demonstrated in laboratory studies. Srinivasan et al. examined the integrity of the cornea and retina as markers for degeneration in non-proliferative diabetic retinopathy. This is good news for diabetic patients, who should be sure to consult regularly with their eye doctor.
What is amniotic membrane and how can it help with diabetic neuropathy
Amniotic membrane, which comes from voluntarily donated placenta after a birth, consists of a thick basement membrane and a stroma that contains a high concentration of basic fibroblast growth factor.
Amniotic membrane has significant anti-inflammatory properties. Amniotic membrane is used in healing wounds because of its many positive properties. Cryopreserved amniotic membrane received approval through Request for Designation from the Food and Drug Administration (FDA) for ocular surface reconstruction in 2001. The FDA ruled that it promotes healing through anti-inflammatory, anti-scarring, and anti-angiogenic effects. Its direct anti-scarring effect is the result of its inhibiting activities of fibroblasts on the ocular surface.
Amniotic membrane can be used in two different ways. First, it can be surgically transplanted as a permanent graft. It is secured with either sutures or fibrin glue. It can fill wounds. The membrane will become part of the host tissue, over time, up to a month. Second, amniotic membrane can be used as a temporary ocular surface patch. The membrane works its properties without integrating but will be removed upon healing if it does not dissolve on its own.
The future of using amniotic tissue for diabetic neuropathy
Amniotic tissue is rich in MSCs, which may have potential for healing diabetic eye wounds in the future. According to the researchers, AMSCs secrete higher levels of certain growth factors than MSCs derived from other sources, such as fat or bone. Also, because amniotic membrane comes from placental tissues that would normally be disposed of, the MSCs are easy to source, and it is easier to isolate MSCs in amniotic tissue. Placenta-derived MSCs have immune regulating functions. They can also migrate from the injection site to a wound. Amniotic MSCs can cross the blood brain barrier, making them good candidates for the treatment of retinopathy.
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