Confocal microscopy of corneal nerve plexus as an early marker of eye involvement in patients with type 2 diabetes

dell’Omo, Roberto; Cifariello, Francesco; Turris, Serena De; Romano, Vito; Renzo, Federico Di; Taranto, Davide Di; Coclite, Giovanni; Agnifili, Luca; Mastropasqua, Leonardo; Costagliola, Ciro

doi:10.1016/j.diabres.2018.06.010

Cited by 27 publications

(21 citation statements)

References 34 publications

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“…In vivo confocal microscopy (IVCM) has become an indispensable tool in the study of corneal physiology and disease, allowing direct noninvasive visualization of small fiber corneal nerve microstructures [10]. In our study, we assessed the structural changes of corneal subbasal nerves in TAO patients via in vivo laser scanning confocal microscopy (LSCM).…”

Section: Introductionmentioning

confidence: 99%

Altered Corneal Nerves in Chinese Thyroid-Associated Ophthalmopathy Patients Observed by In Vivo Confocal Microscopy

Mou

Chen

et al. 2019

Med Sci Monit

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BackgroundThyroid-associated ophthalmopathy (TAO) is a common endocrine autoimmune disease. The present study explored corneal nerve changes in TAO patients.Material/MethodsThirty-eight Chinese TAO patients and 20 healthy individuals were included in the study. Central corneal subbasal nerve density and morphology were evaluated with in vivo laser scanning confocal microscopy and quantified using automated CCmetrics software.ResultsThe values of the central corneal subbasal nerve plexus parameters of both active and inactive TAO patients were significantly decreased compared with those of controls, including corneal nerve fiber density (CNFD) (P<0.001 for both), corneal nerve branch density (CNBD) (P<0.001 for both), corneal nerve fiber length (CNFL) (P<0.001 for both), corneal nerve fiber total branch density (CTBD) (P<0.001 for both), corneal nerve fiber area (CNFA) (P<0.001 for both), corneal nerve fiber width (CNFW) (P=0.046, P=0.027, respectively), and corneal nerve fiber fractal dimension (ACNFrD) (P<0.001 for both). In addition, CNFD and ACNFrD values were significantly lower in the active TAO patients compared with those in the inactive TAO patients (P=0.020, P=0.002, respectively). There were significant correlations between CNFD, CNBD, CNFL, CTBD, CNFA, and ACNFrD and the ocular surface parameters and activity assessment items.ConclusionsAbnormal corneal subbasal nerves were observed in both active and inactive Chinese TAO patients, suggesting that nerve degeneration is associated with the disease. However, the exact underlying mechanisms remain to be elucidated.

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Section: Introductionmentioning

confidence: 99%

Altered Corneal Nerves in Chinese Thyroid-Associated Ophthalmopathy Patients Observed by In Vivo Confocal Microscopy

Mou

Chen

et al. 2019

Med Sci Monit

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“…Many studies show that the nerve fiber features captured from CCM are associated with DPN and even other diabetic chronic complications, such as DR and DN [32][33][34][35] . CNFD, CNFL and CNBD are the most commonly used indicators for CCM to evaluate diabetes mellitus and its complications 25 .…”

Section: Discussionmentioning

confidence: 99%

Diagnostic utility of corneal confocal microscopy in type 2 diabetic peripheral neuropathy

Wang

Zhang²,

Zuo

et al. 2020

J of Diabetes Invest

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Aims/Introduction: The early pathological changes of diabetic peripheral neuropathy (DPN) are mainly small nerve fiber injuries. Corneal confocal microscopy (CCM) is an easy, rapid, non-invasive and repeatable technique to detect the damage of small nerve fibers. The purpose of this study was to explore the application of CCM in DPN and other chronic complications of type 2 diabetes mellitus. Materials and Methods: A total of 220 individuals (48 normal healthy control participants and 172 patients with type 2 diabetes mellitus) were included in the study. All participants were assessed and scored for neurological symptoms and neurological deficits, quantitative sensory test, neuroelectrophysiological test, and CCM. Results: Corneal nerve fiber density, corneal nerve fiber length and corneal nerve branch density were significantly reduced in patients with type 2 diabetes mellitus compared with normal healthy control subjects (P < 0.001, P < 0.001 and P < 0.001, respectively). In the DPN group, corneal nerve fiber density, corneal nerve branch density and corneal nerve fiber length were significantly lower than for patients without DPN (P < 0.001, P < 0.001 and P < 0.001, respectively). Receiver operating characteristic analysis showed that the optimal cutoff values were 24.68, 39 and 15.315, respectively, in which corneal nerve fiber density and corneal nerve fiber length had moderate sensitivity and specificity. Conclusion: This study provides more support for the clinical use of CCM to diagnose type 2 diabetes mellitus-related complications, especially DPN.

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“…Diabetes mellitus regularly results in corneal edema, erosions and changes of the tear film, and worsening corneal epithelial wound healing, despite the fact that it remains undetected clinically in almost 70% of the cases [2,3]. Neuropathy can be diagnosed at an early stage with in vivo corneal confocal microscopy (IVCCM), which is a non-invasive technique that allows the clinician to examine the layers of the cornea accurately [4][5][6]. In addition, optical coherence tomography (OCT) plays a key role in identifying and quantifying the grade of maculopathy in diabetes mellitus [7].…”

Section: Introductionmentioning

confidence: 99%

In vivo corneal confocal microscopy and optical coherence tomography on eyes of participants with type 2 diabetes mellitus and obese participants without diabetes

Tóth

Silver

Balla

et al. 2021

Graefes Arch Clin Exp Ophthalmol

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Purposes To examine corneal nerve and retinal nerve characteristics of participants with type 2 diabetes mellitus (T2DM) compared with obese participants without diabetes to discover potential nerve vulnerabilities. Methods All participants underwent a complete medical examination including a physical examination and blood sample tests. The ophthalmologic examination included best-corrected visual acuity, intraocular pressure, Schirmer test, tear film breakup time, slit-lamp examination, dilated fundus photography, in vivo corneal confocal microscopy (IVCCM), and optical coherence tomography (OCT). Results The study cohort consisted of 83 eyes of 83 individuals: a group of 44 participants with T2DM, and a control group of 39 obese participants with no history of diabetes. Comparing measurements on the two groups, participants with T2DM had lower values with statistical significance for retinal nerve fiber layer (RNFL) nasal superior thickness (p = 0.010) and three corneal nerve (CN) parameters: fiber length (p = 0.025), total branch density (p = 0.013), and fiber area (p = 0.009). There was a borderline significant difference in CN fiber width (p = 0.051) and RNFL nasal inferior thickness (p = 0.056). No other significant differences were observed in the IVCCM and OCT parameters. No statistically significant correlation was found between CN and RNFL parameters. Conclusions Progression from a pre-diabetic obese state to a T2DM condition might entail a loss or diminishment of certain corneal nerve fibers or retinal nerve fibers, but not necessarily a loss of both corneal and retinal nerve fibers simultaneously. Using IVCCM and OCT together enables monitoring of both corneal and retinal health of the eye.

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Confocal microscopy of corneal nerve plexus as an early marker of eye involvement in patients with type 2 diabetes

Cited by 27 publications

References 34 publications

Altered Corneal Nerves in Chinese Thyroid-Associated Ophthalmopathy Patients Observed by In Vivo Confocal Microscopy

Altered Corneal Nerves in Chinese Thyroid-Associated Ophthalmopathy Patients Observed by In Vivo Confocal Microscopy

Diagnostic utility of corneal confocal microscopy in type 2 diabetic peripheral neuropathy

In vivo corneal confocal microscopy and optical coherence tomography on eyes of participants with type 2 diabetes mellitus and obese participants without diabetes

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