Assessing corneal nerve structure and function in diabetic neuropathy

Tavakoli, Mitra; Petropoulos, Ioannis N.; Malik, Rayaz A.

doi:10.1111/j.1444-0938.2012.00743.x

Cited by 55 publications

(47 citation statements)

References 79 publications

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“…Ad-and C-fibers can be clearly distinguished by fiber diameter and, while running in the basal epithelial plexus, by their spatial arrangement. 25,27 The decrease in innervation of corneal epithelium of diabetic rats was mirrored by a decrease in corneal sensitivity as measured by Cochet-Bonnet filament esthesiometer and tear secretion and intraepidermal nerve fiber density in the skin of the hindpaw as well as impairment of other standard endpoints for diabetic neuropathy. Assessing intraepidermal nerve fiber pathology has been shown to be useful in identifying patients with small fiber neuropathy.…”

Section: Discussionmentioning

confidence: 99%

Early Loss of Innervation of Cornea Epithelium in Streptozotocin-Induced Type 1 Diabetic Rats: Improvement with Ilepatril Treatment

Davidson

Coppey

Yorek

2012

Invest. Ophthalmol. Vis. Sci.

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Section: Discussionmentioning

confidence: 99%

Early Loss of Innervation of Cornea Epithelium in Streptozotocin-Induced Type 1 Diabetic Rats: Improvement with Ilepatril Treatment

Davidson

Coppey

Yorek

2012

Invest. Ophthalmol. Vis. Sci.

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“…352 IVCM has shown moderate-to-high specificity for diagnosing diabetic neuropathy, 348 and the utility of using corneal nerves as a biomarker of diabetic neuropathy. 175,348,353 …”

Section: Systemic Diseasesmentioning

confidence: 99%

In Vivo Confocal Microscopy of Corneal Nerves in Health and Disease

2017

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In vivo confocal microscopy (IVCM) is becoming an indispensable tool for studying corneal physiology and disease. Enabling the dissection of corneal architecture at a cellular level, this technique offers fast and noninvasive in vivo imaging of the cornea with images comparable to that of ex vivo histochemical techniques. Corneal nerves bear substantial relevance to clinicians and scientists alike, given their pivotal roles in regulation of corneal sensation, maintenance of epithelial integrity, and proliferation and promotion of wound healing. Thus, IVCM offers a unique method to study corneal nerve alterations in a myriad of conditions, such as ocular and systemic diseases and following corneal surgery, without altering the tissue microenvironment. Of particular interest has been the correlation of corneal subbasal nerves to their function, which has been studied in normal eyes, contact lens wearers, and patients with keratoconus, infectious keratitis, corneal dystrophies, and neurotrophic keratopathy. Longitudinal studies have applied IVCM to investigate the effects of corneal surgery on nerves, demonstrating their regenerative capacity. IVCM is increasingly important in the diagnosis and management of systemic conditions such as peripheral diabetic neuropathy and, more recently, in ocular diseases. In this review, we outline the principles and applications of IVCM in the study of corneal nerves in various ocular and systemic diseases.

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“…The use of corneal confocal microscopy (CCM) for rapid, noninvasive clinical assessment of corneal nerves has grown substantially in recent years (1). It has proven to be particularly useful as a diagnostic marker for the detection of diabetic neuropathy (2–6) and a range of other peripheral neuropathies (7–10).…”

Section: Introductionmentioning

confidence: 99%

Normative Values for Corneal Nerve Morphology Assessed Using Corneal Confocal Microscopy: A Multinational Normative Data Set

et al. 2015

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OBJECTIVECorneal confocal microscopy is a novel diagnostic technique for the detection of nerve damage and repair in a range of peripheral neuropathies, in particular diabetic neuropathy. Normative reference values are required to enable clinical translation and wider use of this technique. We have therefore undertaken a multicenter collaboration to provide worldwide age-adjusted normative values of corneal nerve fiber parameters.RESEARCH DESIGN AND METHODSA total of 1,965 corneal nerve images from 343 healthy volunteers were pooled from six clinical academic centers. All subjects underwent examination with the Heidelberg Retina Tomograph corneal confocal microscope. Images of the central corneal subbasal nerve plexus were acquired by each center using a standard protocol and analyzed by three trained examiners using manual tracing and semiautomated software (CCMetrics). Age trends were established using simple linear regression, and normative corneal nerve fiber density (CNFD), corneal nerve fiber branch density (CNBD), corneal nerve fiber length (CNFL), and corneal nerve fiber tortuosity (CNFT) reference values were calculated using quantile regression analysis.RESULTSThere was a significant linear age-dependent decrease in CNFD (−0.164 no./mm2 per year for men, P < 0.01, and −0.161 no./mm2 per year for women, P < 0.01). There was no change with age in CNBD (0.192 no./mm2 per year for men, P = 0.26, and −0.050 no./mm2 per year for women, P = 0.78). CNFL decreased in men (−0.045 mm/mm2 per year, P = 0.07) and women (−0.060 mm/mm2 per year, P = 0.02). CNFT increased with age in men (0.044 per year, P < 0.01) and women (0.046 per year, P < 0.01). Height, weight, and BMI did not influence the 5th percentile normative values for any corneal nerve parameter.CONCLUSIONSThis study provides robust worldwide normative reference values for corneal nerve parameters to be used in research and clinical practice in the study of diabetic and other peripheral neuropathies.

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Assessing corneal nerve structure and function in diabetic neuropathy

Cited by 55 publications

References 79 publications

Early Loss of Innervation of Cornea Epithelium in Streptozotocin-Induced Type 1 Diabetic Rats: Improvement with Ilepatril Treatment

Early Loss of Innervation of Cornea Epithelium in Streptozotocin-Induced Type 1 Diabetic Rats: Improvement with Ilepatril Treatment

In Vivo Confocal Microscopy of Corneal Nerves in Health and Disease

Normative Values for Corneal Nerve Morphology Assessed Using Corneal Confocal Microscopy: A Multinational Normative Data Set

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