Reduced corneal nerve fibre length in prediabetes and type 2 diabetes: The Maastricht Study

Purpose: To assess the diagnostic utility of corneal confocal microscopy (CCM) for diabetic peripheral neuropathy (DPN) and the risk factors for corneal nerve loss. Methods: 490 participants including 72 healthy controls, 149 with type 1 diabetes and 269 with type 2 diabetes underwent detailed assessment of peripheral neuropathy and CCM in relation to risk factors. Results: Corneal nerve fibre density (CNFD) (P<0.0001, P<0.0001), branch density (CNBD) (P<0.0001, P<0.0001) and length (CNFL) (P<0.0001, P=0.02) were significantly lower in patients with type 1 and type 2 diabetes, compared to controls. CNFD (P<0.0001), CNBD (P<0.0001) and CNFL (P<0.0001) were lower in type 1 diabetes compared to type 2 diabetes. Receiver operating characteristics (ROC) curve analysis for the diagnosis of DPN demonstrated a good area under the curve (AUC) for CNFD=0.81, CNBD=0.74 and CNFL=0.73. Multivariable regression analysis showed a significant association between reduced corneal nerve fibre length with age (β=-0.27, P=0.007), HbA1c (β=-1.1, P=0.01) and weight (β=-0.14, P=0.03) in patients with type 2 diabetes and with duration of diabetes (β=-0.13, P=0.02), LDL cholesterol (β=1.8, P=0.04), and triglycerides (β=-2.87, P=0.009) in patients with type 1 diabetes. Conclusion: CCM identifies more severe corneal nerve loss in patients with type 1 compared to type 2 diabetes and shows good diagnostic accuracy for DPN. Furthermore, the risk factors for a reduction in corneal nerve fibre length differ between type 1 and type 2 diabetes.

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Diagnosis of neuropathy and risk factors for corneal nerve loss in type 1 and type 2 diabetes: A corneal confocal microscopy study

10.2337/figshare.13020023 ◽

2020 ◽

Author(s):

Maryam Ferdousi ◽

Alise Kalteniece ◽

Shazli Azmi ◽

Ioannis N Petropoulos ◽

Georgios Ponirakis ◽

...

Keyword(s):

Risk Factors ◽

Type 2 Diabetes ◽

Type 1 Diabetes ◽

Peripheral Neuropathy ◽

Nerve Fibre ◽

Fibre Length ◽

Corneal Confocal Microscopy ◽

Corneal Nerve

Purpose: To assess the diagnostic utility of corneal confocal microscopy (CCM) for diabetic peripheral neuropathy (DPN) and the risk factors for corneal nerve loss. Methods: 490 participants including 72 healthy controls, 149 with type 1 diabetes and 269 with type 2 diabetes underwent detailed assessment of peripheral neuropathy and CCM in relation to risk factors. Results: Corneal nerve fibre density (CNFD) (P<0.0001, P<0.0001), branch density (CNBD) (P<0.0001, P<0.0001) and length (CNFL) (P<0.0001, P=0.02) were significantly lower in patients with type 1 and type 2 diabetes, compared to controls. CNFD (P<0.0001), CNBD (P<0.0001) and CNFL (P<0.0001) were lower in type 1 diabetes compared to type 2 diabetes. Receiver operating characteristics (ROC) curve analysis for the diagnosis of DPN demonstrated a good area under the curve (AUC) for CNFD=0.81, CNBD=0.74 and CNFL=0.73. Multivariable regression analysis showed a significant association between reduced corneal nerve fibre length with age (β=-0.27, P=0.007), HbA1c (β=-1.1, P=0.01) and weight (β=-0.14, P=0.03) in patients with type 2 diabetes and with duration of diabetes (β=-0.13, P=0.02), LDL cholesterol (β=1.8, P=0.04), and triglycerides (β=-2.87, P=0.009) in patients with type 1 diabetes. Conclusion: CCM identifies more severe corneal nerve loss in patients with type 1 compared to type 2 diabetes and shows good diagnostic accuracy for DPN. Furthermore, the risk factors for a reduction in corneal nerve fibre length differ between type 1 and type 2 diabetes.

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Corneal nerve fibre damage precedes diabetic retinopathy in patients with Type 2 diabetes mellitus

Diabetic Medicine ◽

10.1111/dme.12324 ◽

2013 ◽

Vol 31 (4) ◽

pp. 431-438 ◽

Cited By ~ 45

Author(s):

G. Bitirgen ◽

A. Ozkagnici ◽

R. A. Malik ◽

H. Kerimoglu

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Diabetic Retinopathy ◽

Nerve Fibre ◽

Corneal Nerve

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Faculty Opinions recommendation of Correlation between sudomotor function, sweat gland duct size and corneal nerve fiber pathology in patients with type 2 diabetes mellitus.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718204748.793488266 ◽

2013 ◽

Author(s):

Rayaz Malik

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Nerve Fiber ◽

Sweat Gland ◽

Sudomotor Function ◽

Gland Duct ◽

Corneal Nerve

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Insulin resistance limits corneal nerve regeneration in patients with Type 2 diabetes undergoing intensive glycemic control

Journal of Diabetes Investigation ◽

10.1111/jdi.13582 ◽

2021 ◽

Author(s):

Georgios Ponirakis ◽

Muhammad A. Abdul‐Ghani ◽

Amin Jayyousi ◽

Mahmoud A. Zirie ◽

Salma Al‐Mohannadi ◽

...

Keyword(s):

Insulin Resistance ◽

Type 2 Diabetes ◽

Glycemic Control ◽

Nerve Regeneration ◽

Intensive Glycemic Control ◽

Corneal Nerve

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The Reference Distribution of Annual Change in Corneal Nerve Fibre Length in Diabetes

Canadian Journal of Diabetes ◽

10.1016/j.jcjd.2018.08.029 ◽

2018 ◽

Vol 42 (5) ◽

pp. S10

Author(s):

Evan Jh Lewis ◽

Mitra Tavakoli ◽

Leif E. Lovblom ◽

Elise M. Halpern ◽

Maria Jeziorska ◽

...

Keyword(s):

Nerve Fibre ◽

Fibre Length ◽

Annual Change ◽

Reference Distribution ◽

Corneal Nerve

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Bilateral morphometric analysis of corneal sub-basal nerve plexus in patients undergoing unilateral cataract surgery: a preliminary in vivo confocal microscopy study

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2019-315449 ◽

2020 ◽

pp. bjophthalmol-2019-315449 ◽

Cited By ~ 3

Author(s):

Giuseppe Giannaccare ◽

Federico Bernabei ◽

Marco Pellegrini ◽

Fabio Guaraldi ◽

Federica Turchi ◽

...

Keyword(s):

Confocal Microscopy ◽

Cataract Surgery ◽

Nerve Fibre ◽

Fibre Length ◽

Nerve Plexus ◽

In Vivo Confocal Microscopy ◽

Corneal Nerve ◽

Branch Density ◽

Unilateral Cataract

AimsTo evaluate bilateral morphometric changes of corneal sub-basal nerve plexus (CSNP) occurring after unilateral cataract surgery by in vivo confocal microscopy (IVCM) images analysed with automated software.MethodsIVCM was performed before (V0) and 1 month after surgery (V1) in both operated eyes (OEs) and unoperated eyes (UEs) of 30 patients. Thirty age and sex-matched subjects acted as controls. Corneal nerve fibre density (CNFD), corneal nerve branch density (CNBD), corneal nerve fibre length (CNFL), corneal nerve total branch density (CTBD), corneal nerve fibre area (CNFA), corneal nerve fibre width, corneal nerve fractal dimension (CNFrD) and dendritic cells density were calculated.ResultsMean CNFD, CNBD, CNFL, CTBD, CNFA and CNFrD significantly decreased at V1 versus V0 in both eyes (respectively, 15.35±7.00 vs 21.21±6.56 n/mm2 in OEs and 20.11±6.69 vs 23.20±7.26 in UEs; 13.57±12.16 vs 26.79±16.91 n/mm2 in OEs and 24.28±14.88 vs 29.76±15.25 in UEs; 9.67±3.44 mm/mm2 vs 13.49±3.42 in OEs and 12.53±3.60 vs 14.02±3.82 in UEs; 22.81±18.77 vs 42.25±24.64 n/mm2 in OEs and 38.06±20.52 vs 43.93±22.27 in UEs; 0.0040±0.0021 vs 0.0058±0.0020 mm2/mm2 in OEs and 0.0049±0.0016 vs 0.0057±0.0019 in UEs; 1.418±0.058 vs 1.470±0.037 in OEs and 1.466±0.040 vs 1.477±0.036 in UEs; always p<0.049).ConclusionPatients undergoing cataract surgery exhibit bilateral alterations of CSNP. This finding could have broad implications in the setting of sequential cataract surgery.

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