Corneal nerve and endothelial cell damage in patients with transient ischemic attack and minor ischemic stroke

Abstract

ObjectiveTo determine if corneal confocal microscopy can identify corneal nerve and endothelial cell abnormalities and may be useful in the prognostication of patients with transient ischemic attack [1] or minor ischemic stroke (IS).MethodsThirty-six patients admitted with TIA (n = 14) or minor IS (n = 22) underwent transcranial Doppler evaluation and corneal confocal microscopy and were compared with 18 healthy controls.ResultsCorneal nerve fiber density (P = 0.002), branch density (P = 0.004) and fiber length (P = 0.004) were significantly lower in patients with TIA or minor IS compared to controls, with no difference between patients with TIA and minor IS. Endothelial cell density (P = 0.003) was lower and endothelial cell area (P = 0.003) and perimeter (P = 0.006) were significantly higher in patients with TIA or minor IS compared to controls, with no difference between patients with TIA and minor IS. There were no differences in corneal nerve or endothelial cell morphology between patients with and without abnormal cerebrovascular reactivity. HbA1c was independently associated with CNFL, and endothelial cell polymegathism and pleomorphism were associated with both HbA1c and total cholesterol.ConclusionCorneal confocal microscopy identifies corneal nerve fiber loss and endothelial cell abnormalities in patients with TIA and minor IS and independent associations with HbA1c and cholesterol.

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].…”

“…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

“…Neben der OCT der Retina ist die Konfokalmikroskopie der Kornea (CCM) zur Untersuchung von Alterationen der kornealen Nerven, z. B. im Kontext der diabetischen Neuropathie [5,6], ein höchst innovatives Forschungsgebiet. Neben der reinen oberflächenparallelen Darstellung des subbasalen Nervenplexus (SNP) stellt sich die Frage, wie diese Strukturen großflächig abgebildet und quantifiziert werden können [7,8] und was geeignete Kenngrößen für eine Charakterisierung des SNP sind [9].…”

“…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].…”