Purpose: To calculate the prevalence of all vitreomacular interface (VMI) disorders and stratify according to age, sex and (pre)diabetes status.Methods: The presence of VMI disorders was assessed in 2660 participants aged between 40 and 75 years from The Maastricht Study who had a gradable macular spectral‐domain optical coherence tomography (SD‐OCT) volume scan in at least one eye [mean 59.7 ± 8.2 years, 50.2% men, 1531 normal glucose metabolism (NGM), 401 prediabetes, 728 type 2 diabetes (DM2, oversampled)]. A stratified and multivariable logistic regression analysis was used.Results: The prevalence of the different VMI disorders for individuals with NGM, prediabetes and DM2 was, respectively, 5.7%, 6% and 6.7% for epiretinal membranes; 6%, 9.6% and 6.8% for vitreomacular traction; 1.1%, 0.7% and 0.3% for lamellar macular holes; 0.1%, 0% and 0% for pseudoholes; 1.1%, 1.9% and 5.5% for macular cysts. None of the participants was diagnosed with a macular hole. The prevalence of epiretinal membranes, vitreomacular traction and macular cysts was higher with age (p < 0.001). Vitreomacular traction and lamellar macular holes were more frequent in women (p < 0.01). DM2 is positively associated [OR = 3.9 (95% CI 2.11–7.22, p < 0.001)] with macular cysts and negatively associated with lamellar macular holes [OR = 0.2 (95% CI 0.04–0.9, p = 0.036)] after adjustment for age and sex. The calculated prevalence of VMI disorders was 15.9%.Conclusions: The calculated prevalence of VMI disorders in individuals aged between 40 and 75 years is 15.9%. The prevalence depends on age, sex and glucose metabolism status for several types of VMI disorders.

Purpose: In individuals with diabetes, injury to the corneal nerve fibres predisposes to delayed corneal epithelial healing, reduced corneal sensitivity and corneal erosion. We investigated to what extent a reduction in corneal nerve fibre length (CNFL) is present in individuals with prediabetes or type 2 diabetes (DM2) compared with individuals with normal glucose metabolism (NGM).Methods: Using composite images acquired by corneal confocal microscopy, we assessed total CNFL per mm² in the subbasal nerve plexus of the cornea in 134 participants (mean age 59 ± 8 years, 49% men, 87 NGM, 20 prediabetes, 27 DM2). Multivariable linear regression was used to assess the association between CNFL and glucose metabolism status, adjusted for age and sex.Results: In individuals with type 2 diabetes, the mean CNFL was significantly reduced [β = −1.86 mm/mm² (95% CI −3.64 to −0.08), p = 0.04], as compared with individuals with normal glucose metabolism after adjustment for age and sex. Part of the reduction was present in individuals with prediabetes [β = −0.96 mm/mm² (95% CI −2.91 to 0.99), p = 0.34], with a linear trend of corneal nerve fibre reduction with severity of glucose metabolism status (p trend = 0.04).Conclusions: A significant reduction in CNFL was found in individuals with DM2 compared with individuals with NGM. A trend of reduction in CNFL was observed between individuals with NGM and prediabetes. The reduction in corneal nerve fibre length could contribute to a delayed corneal healing and an increased risk for corneal complications after surgery.

Purpose: The purpose of this study was to assess thinning of the peripapillary retinal nerve fiber layer (RNFL) in prediabetes or type 2 diabetes without diabetic retinopathy (DM2 w/o DRP) compared with that in individuals with normal glucose metabolism (NGM). Methods: We measured sectoral and mean RNFL thickness in a 3.45-mm-diameter circular scan centered on the optic nerve head, using spectral domain optical coherence tomography in 1172 participants from The Maastricht Study (a population-based cohort of individuals 59 ± 8 years of age, 47% men, 699 NGM, 186 with prediabetes, and 287 with DM2 w/o DRP). Multivariate linear regression was used to assess the association between RNFL thickness and glucose metabolism status, adjusted for age and sex. Results: In individuals with prediabetes, the temporal RNFL was thinner than that in individuals with NGM after adjustment (β = −2.28 μm [95% confidence interval [CI], −4.44 to −0.13], P = 0.04), whereas in individuals with DM2 w/o DRP, the temporal inferior (β = −3.66 μm [95% CI, −6.46 to −0.85], P = 0.01), the temporal superior (β = −2.99 μm [95% CI, −5.95 to −0.02], P = 0.05), the temporal (β = −2.73 μm [95% CI, −4.62 to −0.84], P < 0.01), and the mean RNFL (β = −1.88 μm [95% CI, −3.51 to −0.26], P = 0.02) were thinner than those in individuals with NGM. Conclusions: Temporal RNFL thinning is already present in individuals with prediabetes. More widespread RNFL thinning occurs in individuals with DM2 w/o DRP, that is before vascular changes are detected. This suggests preferential retinal nerve fiber layer loss in areas related to the papillomacular bundle.

(1) Background: Mid-stromal isolated Bowman layer transplantation aims to reduce and stabilize corneal ectasia in patients with advanced, progressive keratoconus. The purpose of this review is to evaluate the effectiveness and safety of this new surgical technique. (2) Methods: Following the PRISMA statement and checklist, we searched Medline, the Cochrane Controlled Trials Register, and Embase and used a broad systematic search strategy according to the Cochrane Collaboration. (3) Results: Eight studies with a total number of 120 eyes of 106 patients met our inclusion criteria. One month after Bowman layer transplantation, patients with keratoconus showed a significant decrease in the measured simulated keratometry (−4.74 D [95% CI −6.79 to −2.69]) and the maximum keratometry (−7.41 D [95% CI −9.64 to −5.19]), which remained significant one year postoperatively (−2.91 D [95% CI −5.29 to −0.53] and −5.80 D [−8.49 to −3.12]). Intra- and postoperative complications were observed in 3% and 9% of the patients, respectively. An estimated success rate of 75% to 85% was achieved by experienced surgeons at 5 to 8 years postoperatively. (4) Conclusions: Bowman layer transplantation may be an effective and safe treatment option in patients with advanced, progressive keratoconus. Additional multicenter prospective interventional studies are needed to confirm these preliminary findings.