Corneal Confocal Microscopy detects a Reduction in Corneal Endothelial Cells and Nerve Fibres in Patients with Acute Ischemic Stroke

Abstract

Endothelial dysfunction and damage underlie cerebrovascular disease and ischemic stroke. We undertook corneal confocal microscopy (CCM) to quantify corneal endothelial cell and nerve morphology in 146 patients with an acute ischemic stroke and 18 age-matched healthy control participants. Corneal endothelial cell density was lower (P < 0.001) and endothelial cell area (P < 0.001) and perimeter (P < 0.001) were higher, whilst corneal nerve fibre density (P < 0.001), corneal nerve branch density (P < 0.001) and corneal nerve fibre length (P = 0.001) were lower in patients with acute ischemic stroke compared to controls. Corneal endothelial cell density, cell area and cell perimeter correlated with corneal nerve fiber density (P = 0.033, P = 0.014, P = 0.011) and length (P = 0.017, P = 0.013, P = 0.008), respectively. Multiple linear regression analysis showed a significant independent association between corneal endothelial cell density, area and perimeter with acute ischemic stroke and triglycerides. CCM is a rapid non-invasive ophthalmic imaging technique, which could be used to identify patients at risk of acute ischemic stroke.

Corneal confocal microscopy identifies greater corneal nerve damage in patients with a recurrent compared to first ischemic stroke

“…This is the first study to show greater corneal nerve loss in patients with recurrent ischemic stroke compared to a 1 st ischemic stroke. This extends our previous findings demonstrating corneal nerve loss in patients with TIA [31] and acute ischemic stroke [32,33]. Individual vascular risk factors such as diabetes, hypertension, smoking, dyslipidemia and metabolic syndrome are associated with the risk of a first and recurrent ischemic stroke [5-7, 13, 43].…”

“…MRI studies have shown that structural alterations including white matter hyperintensities, lacunes and microbleeds are associated with an increased risk of recurrent ischemic stroke [9,13,15]. We have previously shown a loss of corneal nerves in subjects with a major ischemic stroke compared to controls and an association between corneal nerve loss with HbA1c and triglycerides [32,33]. In the present study, despite age, BMI, HbA 1c , lipids, BP and use of medications to treat blood pressure and lipids being comparable between those with recurrent stroke and 1 st stroke, there was greater corneal nerve damage in patients with recurrent compared to 1 st stroke.…”

“…This technique has identified axonal loss in diabetes [21][22][23], impaired glucose tolerance [24], other peripheral neuropathies [25,26], Parkinson's disease [27], amyotrophic lateral sclerosis [28], multiple sclerosis [29] and dementia [30]. More recently we have shown a significant loss of corneal nerves in patients with TIA [31] and acute ischemic stroke [32][33][34], which was associated with elevated triglycerides and HbA 1c . Vascular risk factors including dysglycemia and dyslipidemia [35] and hypertension [36] are associated with corneal nerve loss and an improvement in blood pressure, lipids, HbA 1c [37] and glucose tolerance [38] are associated with an improvement in corneal nerve morphology.…”

Digitale Bildverarbeitung und Tiefe Neuronale Netze in der Augenheilkunde – aktuelle Trends

“…können auch durch andere Primärerkrankungen hervorgerufene Veränderungen des SNP und des Endotheliums untersucht werden, wie z. B. die Auswirkungen von ischämischen Schlaganfällen [5,11].…”

Corneal confocal microscopy demonstrates minimal evidence of distal neuropathy in children with celiac disease

“…Quantitative sensory testing to evaluate vibration and thermal perception thresholds are easy to perform, but lack reproducibility, especially in children and skin or nerve biopsies are invasive procedures [12]. Corneal confocal microscopy (CCM) is a rapid, non-invasive and well-tolerated ophthalmic imaging technique that has been used to objectively quantify neurodegeneration in adults with metabolic [13][14][15][16][17][18][19][20], cerebrovascular [21][22][23][24] and central neurodegenerative [25][26][27][28] diseases. We have also shown a significant reduction in corneal nerve fibre density, branch density and length in children and adolescents with type 1 diabetes mellitus (T1DM) [29,30] and progression over time [31].…”