Safety and efficacy of keratorefractive surgery in diabetes mellitus: A clinical review

Table 1 Preoperative evaluation in keratorefractive surgery in diabetic patients

History
Detailed diabetic history	Onset, progression, medication regimen, and altered sensations in the lower extremities
Ocular history	Variations in visual acuity, chronic or recurrent infections, corneal erosions, and dry eye on waking up
Physical examination	Microfilament exam to rule out neuropathy, examination of the foot for ulcer
Slit-lamp examination	Periorbita, tear function, cornea, corneal sensations/esthesiometry, basement membrane health, posterior segment examination
Laboratory investigations	Fasting serum glucose: 130 mg/dL, glycated haemoglobin ≤ 7.9%, Urinalysis: Optional

Table 2 Various drugs and molecules used in the management of diabetic keratopathy

Drug	Indication and action
Topical autologous serum	Promotes corneal wound healing
Topical thymosin β4	Non-healing epithelial defect
Topical insulin	Prevents loss of sub-basal nerve plexus. Quicker re-epithelialization after epithelial scraping for vitreoretinal surgeries promotes wound healing
Topical CT-112	Reduction in corneal barrier effect
Injection of insulin-like growth factor-1	Prevention of stem cell loss and improvement of sub-basal nerve plexus density
Topical ranirestat	Promote wound healing, control the expression of matrix metalloproteinases-10, and integrin α3 expression
Nateglinide and glibenclamide	Inhibit Descemet’s membrane changes
Topical naltrexone	Normalize corneal epithelial wound healing, tear film, and corneal sensations
Topical nerve growth factor	Reduced apoptosis and inflammation
Ciliary neurotrophic factor	Improve epithelial stem cells, increase nerve density, and promote epithelial healing
Substance P	Improved wound healing, reinnervation, and reactivation of epidermal growth factor receptor/AKT signaling
Interleukin-1 antagonists	Reduced apoptosis, faster wound healing, sensory stimulation, improved AKT signaling

AKT: Protein kinase B.