Greater corneal nerve loss at the inferior whorl is related to the presence of diabetic neuropathy and painful diabetic neuropathy

Alise Kalteniece, Maryam Ferdousi, Ioannis Petropoulos, Shazli Azmi, Safwaan Adam, Hassan Fadavi, Andrew Marshall, Andrew J. M. Boulton, Nathan Efron, Catharina G. Faber, Giuseppe Lauria, Handrean Soran, Rayaz A. Malik*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

We assessed whether a measure of more distal corneal nerve fibre loss at the inferior whorl(IW) region is better than proximal measures of central corneal nerve damage in relation to the diagnosis of diabetic peripheral neuropathy(DPN), painful DPN and quality of life(QoL). Participants underwent detailed assessment of neuropathy, QoL using the SF36 questionnaire, pain visual analogue score(VAS), and corneal confocal microscopy(CCM). Corneal nerve fibre density (CNFD), branch density (CNBD) and length (CNFL) at the central cornea and inferior whorl length (IWL) and average(ANFL) and total(TNFL) nerve fibre length were compared in patients with and without DPN and between patients with and without painful DPN and in relation to QoL. All CCM parameters were significantly reduced, but IWL was reduced similar to three-fold greater than CNFL in patients with and without DPN compared to controls. IWL(p = 0.001), ANFL(p = 0.01) and TNFL(p = 0.02) were significantly lower in patients with painful compared to painless DPN. The VAS score correlated with IWL(r = -0.36, P = 0.004), ANFL(r = -0.32, P = 0.01) and TNFL(r = -0.32, P = 0.01) and QoL correlated with CNFL(r = 0.35, P = 0.01) and IWL(r = 0.4, P = 0.004). Corneal nerve fibre damage is more prominent at the IW, lower in patients with painful compared to painless neuropathy and relates to their QoL. IWL may provide additional clinical utility for CCM in patients with DPN.
Original languageEnglish
Article number3283
Number of pages8
JournalScientific Reports
Volume8
DOIs
Publication statusPublished - 19 Feb 2018

Keywords

  • CONFOCAL MICROSCOPY
  • PERIPHERAL NEUROPATHY
  • FIBER DAMAGE
  • POLYNEUROPATHY
  • PLEXUS
  • POPULATION
  • PREVALENCE
  • SURROGATE
  • SEVERITY
  • SF-36

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