Author Response: Small Fiber Neuropathy and Wilson Disease

Abstract

We appreciate the comments that Gondim and Gurgen Filha 1 have reported about our article, 2 which has demonstrated, for the first time, corneal nerve fiber involvement in Wilson disease documented by corneal confocal microscopy. They report the use of confocal microscopy, not corneal but reflectance skin confocal microscopy, to determine Meissner corpuscle changes in sensory neuropathy, a different field of investigation compared with our article. 3 Moreover, the original article was written by Herrmann et al. 4 It is not new that corneal confocal microscopy is able to demostrate small fiber peripheral neuropathy in diabetes, and we were the first research group to introduce in the literature the term ''corneal diabetic neuropathy,'' in 2006. 5 We have reviewed the article by Gondim et al. 6 about small fiber dysfunction in Wilson disease, but it has nothing to do with our investigation. Skin wrinkling test has never been compared with corneal confocal study of subbasal nerve plexus, and it may represent a topic for future studies. In our population, we did not find any difference in corneal involvement, even when separately evaluating central nervous system versus pure hepatic involvement. We congratulate Gondim et al. 6 for their prospective studies, and we hope they are able to include the evaluation of cornal subasal nerve plexus by corneal confocal microscopy in their prospective analysis.