Furthermore, though a report suggesting that acute exposure to elevated glucose alone may not promote altered keratocyte marker expression, e.g. keratocan and lumican, by healthy corneal stromal stem cells in vitro41, stimulation with chronic hyperglycemia may promote a differential response in corneal fibroblasts isolated from DM patients due to permanent mitochondrial damage and increased ECM thickness22. This evidence concerns the gene KERA and Hyperglycemia.