TY - JOUR
T1 - Diabetic Neuropathy Is Characterized by Progressive Corneal Nerve Fiber Loss in the Central and Inferior Whorl Regions
AU - Ferdousi, Maryam
AU - Kalteniece, Alise
AU - Petropoulos, Ioannis
AU - Azmi, Shazli
AU - Dhage, Shaishav
AU - Marshall, Andrew
AU - Boulton, Andrew J. M.
AU - Efron, Nathan
AU - Faber, Catharina G.
AU - Lauria, Giuseppe
AU - Soran, Handrean
AU - Malik, Rayaz A.
N1 - Funding Information:
Supported by the Manchester Biomedical Research Centre and the Greater Manchester Comprehensive Local Research Network. Also supported by the European Union Seventh Framework Programme FP7/2007-2013 (n°602273), National Institutes of Health (R01DK077903-0101; Bethesda, MD, USA), and Juvenile Diabetes Research Foundation International (27-2008-362). The authors alone are responsible for the content and writing of the article.
Publisher Copyright:
Copyright 2020 The Authors.
PY - 2020/3
Y1 - 2020/3
N2 - PURPOSE. We hypothesized that longitudinal changes in corneal nerve morphology would differ between the central cornea and inferior whorl in relation to other measures of diabetic neuropathy.METHODS. Thirty patients with diabetes (age: 54.08 +/- 15.86, duration: 23.95 +/- 14.2, HbA1c: 7.51 +/- 1.37) and 19 age-matched healthy controls (age: 49.47 +/- 13.25) underwent assessment of neuropathy disability score (NDS), vibration perception threshold (VPT), cold (CPT) and warm (WPT) perception thresholds, peroneal motor nerve conduction velocity (PMNCV), corneal nerve fiber density (CNFD), branch density (CNBD), fiber length (CNFL), inferior whorl length (IWL), and the average of CNFL and IWL (ANFL) at baseline and after 1 to 8 years.RESULTS. In patients with diabetes, between baseline and follow-up, there was a significant reduction in CNBD (57.72 +/- 30.08 vs. 44.04 +/- 23.69; P = 0.02), CNFL (21.77 +/- 5.19 vs. 15.65 +/- 4.7; P <0.0001), IWL (24.69 +/- 8.67 vs. 14.23 +/- 6.13; P <0.0001), ANFL (23.26 +/- 5.53 vs. 15.09 +/- 4.48; P <0.0001), and WPT (43.56 +/- 4.43 vs. 40.78 +/- 4.93; P = 0.01), and an increase in VPT (12.9 +/- 8.96 vs. 13.78 +/- 8.99; P = 0.02). There was no significant change in CNFD (27.12 +/- 8.2 vs. 25.43 +/- 7.11; P = 0.2), NDS (3.38 +/- 3.35 vs. 2.61 +/- 2.8; P = 0.08), CPT (17.7 +/- 10.59 vs. 22.45 +/- 9.23; P = 0.06), or PMNCV (42.4 +/- 4.21 vs. 42.16 +/- 6.3; P = 0.2).CONCLUSIONS. There is evidence of corneal nerve loss in patients with diabetes, particularly at the inferior whorl during follow-up.
AB - PURPOSE. We hypothesized that longitudinal changes in corneal nerve morphology would differ between the central cornea and inferior whorl in relation to other measures of diabetic neuropathy.METHODS. Thirty patients with diabetes (age: 54.08 +/- 15.86, duration: 23.95 +/- 14.2, HbA1c: 7.51 +/- 1.37) and 19 age-matched healthy controls (age: 49.47 +/- 13.25) underwent assessment of neuropathy disability score (NDS), vibration perception threshold (VPT), cold (CPT) and warm (WPT) perception thresholds, peroneal motor nerve conduction velocity (PMNCV), corneal nerve fiber density (CNFD), branch density (CNBD), fiber length (CNFL), inferior whorl length (IWL), and the average of CNFL and IWL (ANFL) at baseline and after 1 to 8 years.RESULTS. In patients with diabetes, between baseline and follow-up, there was a significant reduction in CNBD (57.72 +/- 30.08 vs. 44.04 +/- 23.69; P = 0.02), CNFL (21.77 +/- 5.19 vs. 15.65 +/- 4.7; P <0.0001), IWL (24.69 +/- 8.67 vs. 14.23 +/- 6.13; P <0.0001), ANFL (23.26 +/- 5.53 vs. 15.09 +/- 4.48; P <0.0001), and WPT (43.56 +/- 4.43 vs. 40.78 +/- 4.93; P = 0.01), and an increase in VPT (12.9 +/- 8.96 vs. 13.78 +/- 8.99; P = 0.02). There was no significant change in CNFD (27.12 +/- 8.2 vs. 25.43 +/- 7.11; P = 0.2), NDS (3.38 +/- 3.35 vs. 2.61 +/- 2.8; P = 0.08), CPT (17.7 +/- 10.59 vs. 22.45 +/- 9.23; P = 0.06), or PMNCV (42.4 +/- 4.21 vs. 42.16 +/- 6.3; P = 0.2).CONCLUSIONS. There is evidence of corneal nerve loss in patients with diabetes, particularly at the inferior whorl during follow-up.
KW - CONFOCAL MICROSCOPY
KW - DAMAGE
KW - MORPHOLOGY
KW - PERIPHERAL NEUROPATHY
KW - PLEXUS
KW - RISK-FACTORS
KW - SEVERITY
KW - corneal confocal microscopy
KW - corneal nerves
KW - diabetes mellitus
U2 - 10.1167/iovs.61.3.48
DO - 10.1167/iovs.61.3.48
M3 - Article
C2 - 32232351
SN - 0146-0404
VL - 61
JO - Investigative Ophthalmology & Visual Science
JF - Investigative Ophthalmology & Visual Science
IS - 3
M1 - 48
ER -