Morphologic Alterations of Both the Stromal and Subbasal Nerves in the Corneas of Patients with Diabetes

Mocan, Mehmet Cem; Durukan, İrfan; İrkeç, Murat; Orhan, Mehmet

doi:10.1097/01.ico.0000224640.58848.54

Cited by 121 publications

(92 citation statements)

References 20 publications

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“…While nerve branch density (NBD) measured as the number of nerve branches per mm 2 is an IVCM parameter that has been shown to be reduced in diabetes in several studies, 4,6,8,15,34,35 the level of reduction is highly variable, 21 and NBD reflects only the number of branching points and not the actual length of the secondary branches. Secondary nerve branch length outside the apical region may therefore be an interesting parameter to concisely define and quantify in future studies, provided that a method is used to reliably image as many such branches as possible.…”

Section: Discussionmentioning

confidence: 99%

Reduced Corneal Nerve Fiber Density in Type 2 Diabetes by Wide-Area Mosaic Analysis

Lagali

Allgeier

Guimarães

et al. 2017

Invest. Ophthalmol. Vis. Sci.

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Citation: Lagali NS, Allgeier S, Guimarães P, et al. Reduced corneal nerve fiber density in type 2 diabetes by wide-area mosaic analysis. Invest Ophthalmol Vis Sci. 2017;58:6318-6327. DOI:10.1167/iovs.17-22257 PURPOSE. To determine if corneal subbasal nerve plexus (SBP) parameters derived from widearea depth-corrected mosaic images are associated with type 2 diabetes. METHODS.One hundred sixty-three mosaics were produced from eyes of 82 subjects by laserscanning in vivo confocal microscopy (IVCM). Subjects were of the same age, without (43 subjects) or with type 2 diabetes (39 subjects). Mosaic corneal nerve fiber length density (mCNFL) and apical whorl corneal nerve fiber length density (wCNFL) were quantified and related to the presence and duration of diabetes (short duration < 10 years and long duration ‡ 10 years).RESULTS. In mosaics with a mean size of 6 mm 2 in subjects aged 69.1 6 1.2 years, mCNFL in type 2 diabetes was reduced relative to nondiabetic subjects (13.1 6 4.2 vs. 15.0 6 3.2 mm/ mm 2 , P ¼ 0.018). Also reduced relative to nondiabetic subjects was mCNFL in both shortduration (14.0 6 4.0 mm/mm 2 , 3.2 6 3.9 years since diagnosis) and long-duration diabetes (12.7 6 4.2 mm/mm 2 , 15.4 6 4.2 years since diagnosis; ANOVA P ¼ 0.023). Lower mCNFL was associated with presence of diabetes (P ¼ 0.032) and increased hemoglobin A1c (HbA1c) levels (P ¼ 0.047). By contrast, wCNFL was unaffected by diabetes or HbA1c (P > 0.05). Global SBP patterns revealed marked degeneration of secondary nerve fiber branches outside the whorl region in long-duration diabetes.CONCLUSIONS. Wide-area mosaic images provide reference values for mCNFL and wCNFL and reveal a progressive degeneration of the SBP with increasing duration of type 2 diabetes.

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Section: Discussionmentioning

confidence: 99%

Reduced Corneal Nerve Fiber Density in Type 2 Diabetes by Wide-Area Mosaic Analysis

Lagali

Allgeier

Guimarães

et al. 2017

Invest. Ophthalmol. Vis. Sci.

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“…The technique is described in detail elsewhere. 13 IVCM was performed only on the central and paracentral corneal zones of all subjects. As detailed in our previous study, 11 the corneal endothelium was first examined with slitlamp biomicroscopy to identify the region of the central or the paracentral cornea in which the KP were most densely deposited; IVCM was specifically performed on this region.…”

Section: Confocal Microscopy In Vivomentioning

confidence: 99%

In vivo confocal microscopic evaluation of keratic precipitates and endothelial morphology in Fuchs’ uveitis syndrome

Mocan

Kadayıfçılar

İrkeç

2011

Eye

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Purpose To evaluate the endothelial cell layer in patients with Fuchs' uveitis syndrome (FUS) with respect to the type and distribution of keratic precipitates (KP), endothelial cell morphology, and endothelial cell density (ECD), using in vivo confocal microscopy (IVCM). Methods Forty eyes of 40 patients (mean age of 32.2 ± 12.5 years) with the clinical diagnosis of FUS were evaluated with IVCM (Confoscan 3.0, Vigonza, Italy). KP were classified as type I (small, round), type II (stippled), type III (dendritiform), and type IV (globular). When 41 KP type was present, differentiation between the predominant and less frequent KP was made as 'primary' and 'secondary'. ECD was measured and compared with age-matched 60 control subjects. Endothelial blebs were classified as small (3-10 lm) or large (410 lm). Results In 36 (90.0%) cases with FUS, more than one KP type was observed with IVCM. Type III (dendritiform) KP was the most frequently observed primary KP type (85.0%), followed by type II (stippled) KP (15.0%). Secondary KP included type II (58.3%), type IV (globular) (27.8%), and type III (13.9%). The mean endothelial cell density of eyes with FUS (2588±396 cells/mm 2 ) was significantly lower than that of control subjects (2930 ± 364 cells/mm 2 ) (t-test; Po0.001). Eyes with FUS had lower proportion of hexagonal cells and higher percentage of polymegethism compared with the uninvolved contralateral eyes. Endothelial blebs (21 small, 16 large blebs) were observed in 37 (92.5%) eyes.Conclusions FUS is characterized by dendritiform KP and is associated with decreased ECD and altered endothelial cell morphology.

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“…The technique is described in detail elsewhere. 8 Before image acquisition, the corneal endothelium was examined with SLE to identify the region of the cornea in which the KPs were most densely deposited. This area was determined to be either the central or the inferior paracentral cornea for all cases studied.…”

Section: Confocal Microscopy In Vivomentioning

confidence: 99%

Keratic precipitate morphology in uveitic syndromes including Behçet's disease as evaluated with in vivo confocal microscopy

Mocan

Kadayıfçılar

İrkeç

2008

Eye

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Purpose To identify the morphologic appearance of keratic precipitates (KPs) with in vivo confocal microscopy (IVCM) in uveitic syndromes. Methods A total of 75 eyes of 72 patients with a mean age of 38.6±15.1 years who had active intraocular inflammation and whose corneas had KP on slit-lamp examination were included in this study. IVCM (Confoscan 3.0, Vigonza, Italy) was used to image the part of the corneal endothelium in which KP were most densely deposited. KP were classified into five groups: type I (small, round), type II (stippled), type III (dendritiform), type IV (large, smooth-rounded), and type V (globular). When more than one type of KP was observed with IVCM, a distinction between the predominant and the less frequent KP was made as 'primary' and 'secondary' KP. Results In 50 (66.7%) eyes more than one type of KP was imaged. The size of the KP ranged between 5 and 150 lm. The most frequently observed primary KP type in Behçet's disease was type I (100%), in ankylosing spondylitis type II (57.1%), in Fuchs' uveitis syndrome type III (85.7%), in granulomatous uveitis type V (42.9%), in infectious uveitis type III (66.7%), and in juvenile idiopathic arthritis associated uveitis type I (66.7%). The KP types showed a statistically significant difference between different uveitic syndromes (Fisher's exact test, Po0.001). Conclusions Certain KP types appear to be characteristic of various uveitic syndromes. IVCM may have a potential role in the diagnostic work-up of uveitic patients.

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Morphologic Alterations of Both the Stromal and Subbasal Nerves in the Corneas of Patients with Diabetes

Abstract: Both stromal and subbasal nerves appear abnormal in the corneas of patients with diabetes. Patients with proliferative diabetic retinopathy show more pronounced nerve alterations than patients who do not have diabetic retinopathy.

Cited by 121 publications

References 20 publications

Reduced Corneal Nerve Fiber Density in Type 2 Diabetes by Wide-Area Mosaic Analysis

Reduced Corneal Nerve Fiber Density in Type 2 Diabetes by Wide-Area Mosaic Analysis

In vivo confocal microscopic evaluation of keratic precipitates and endothelial morphology in Fuchs’ uveitis syndrome

Keratic precipitate morphology in uveitic syndromes including Behçet's disease as evaluated with in vivo confocal microscopy

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