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

Eline E B De Clerck; Jan S A G Schouten; Tos T J M Berendschot; Renée S Koolschijn; Rudy M M A Nuijts; Miranda T Schram; Nicolaas C Schaper; Ronald M A Henry; Pieter C Dagnelie; Alfredo Ruggeri; Pedro Guimarães; Coen D A Stehouwer; Carroll A B Webers

doi:10.1111/aos.14359

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

Eline E B De Clerck^*, Jan S A G Schouten, Tos T J M Berendschot, Renée S Koolschijn, Rudy M M A Nuijts, Miranda T Schram, Nicolaas C Schaper, Ronald M A Henry, Pieter C Dagnelie, Alfredo Ruggeri, Pedro Guimarães, Coen D A Stehouwer, Carroll A B Webers

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

PURPOSE: In individuals with diabetes, injury to the corneal nerve fibres predisposes to delayed corneal epithelial healing, reduced corneal sensitivity and corneal erosion. We investigated to what extent a reduction in corneal nerve fibre length (CNFL) is present in individuals with prediabetes or type 2 diabetes (DM2) compared with individuals with normal glucose metabolism (NGM).

METHODS: Using composite images acquired by corneal confocal microscopy, we assessed total CNFL per mm2 in the subbasal nerve plexus of the cornea in 134 participants (mean age 59 ± 8 years, 49% men, 87 NGM, 20 prediabetes, 27 DM2). Multivariable linear regression was used to assess the association between CNFL and glucose metabolism status, adjusted for age and sex.

RESULTS: In individuals with type 2 diabetes, the mean CNFL was significantly reduced [β = -1.86 mm/mm2 (95% CI -3.64 to -0.08), p = 0.04], as compared with individuals with normal glucose metabolism after adjustment for age and sex. Part of the reduction was present in individuals with prediabetes [β = -0.96 mm/mm2 (95% CI -2.91 to 0.99), p = 0.34], with a linear trend of corneal nerve fibre reduction with severity of glucose metabolism status (p trend = 0.04).

CONCLUSIONS: A significant reduction in CNFL was found in individuals with DM2 compared with individuals with NGM. A trend of reduction in CNFL was observed between individuals with NGM and prediabetes. The reduction in corneal nerve fibre length could contribute to a delayed corneal healing and an increased risk for corneal complications after surgery.

Original language	English
Pages (from-to)	485-491
Number of pages	7
Journal	Acta Ophthalmologica
Volume	98
Issue number	5
Early online date	3 Feb 2020
DOIs	https://doi.org/10.1111/aos.14359
Publication status	Published - Aug 2020

Keywords

COMPLICATIONS
CONFOCAL MICROSCOPY
DENSITY
GLUCOSE-TOLERANCE
INNERVATION
NEUROPATHY
OPHTHALMIC MARKERS
PLEXUS
RETINOPATHY
SENSITIVITY
corneal confocal microscopy
corneal nerves
prediabetes
type 2 diabetes

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De Clerck, E. E. B., Schouten, J. S. A. G., Berendschot, T. T. J. M., Koolschijn, R. S., Nuijts, R. M. M. A., Schram, M. T., Schaper, N. C., Henry, R. M. A., Dagnelie, P. C., Ruggeri, A., Guimarães, P., Stehouwer, C. D. A., & Webers, C. A. B. (2020). Reduced corneal nerve fibre length in prediabetes and type 2 diabetes: The Maastricht Study. Acta Ophthalmologica, 98(5), 485-491. https://doi.org/10.1111/aos.14359

@article{816e814bde04499d98e676cd85ab4f62,

title = "Reduced corneal nerve fibre length in prediabetes and type 2 diabetes: The Maastricht Study",

abstract = "PURPOSE: In individuals with diabetes, injury to the corneal nerve fibres predisposes to delayed corneal epithelial healing, reduced corneal sensitivity and corneal erosion. We investigated to what extent a reduction in corneal nerve fibre length (CNFL) is present in individuals with prediabetes or type 2 diabetes (DM2) compared with individuals with normal glucose metabolism (NGM).METHODS: Using composite images acquired by corneal confocal microscopy, we assessed total CNFL per mm2 in the subbasal nerve plexus of the cornea in 134 participants (mean age 59 ± 8 years, 49% men, 87 NGM, 20 prediabetes, 27 DM2). Multivariable linear regression was used to assess the association between CNFL and glucose metabolism status, adjusted for age and sex.RESULTS: In individuals with type 2 diabetes, the mean CNFL was significantly reduced [β = -1.86 mm/mm2 (95% CI -3.64 to -0.08), p = 0.04], as compared with individuals with normal glucose metabolism after adjustment for age and sex. Part of the reduction was present in individuals with prediabetes [β = -0.96 mm/mm2 (95% CI -2.91 to 0.99), p = 0.34], with a linear trend of corneal nerve fibre reduction with severity of glucose metabolism status (p trend = 0.04).CONCLUSIONS: A significant reduction in CNFL was found in individuals with DM2 compared with individuals with NGM. A trend of reduction in CNFL was observed between individuals with NGM and prediabetes. The reduction in corneal nerve fibre length could contribute to a delayed corneal healing and an increased risk for corneal complications after surgery.",

keywords = "COMPLICATIONS, CONFOCAL MICROSCOPY, DENSITY, GLUCOSE-TOLERANCE, INNERVATION, NEUROPATHY, OPHTHALMIC MARKERS, PLEXUS, RETINOPATHY, SENSITIVITY, corneal confocal microscopy, corneal nerves, prediabetes, type 2 diabetes",

author = "{De Clerck}, {Eline E B} and Schouten, {Jan S A G} and Berendschot, {Tos T J M} and Koolschijn, {Ren{\'e}e S} and Nuijts, {Rudy M M A} and Schram, {Miranda T} and Schaper, {Nicolaas C} and Henry, {Ronald M A} and Dagnelie, {Pieter C} and Alfredo Ruggeri and Pedro Guimar{\~a}es and Stehouwer, {Coen D A} and Webers, {Carroll A B}",

note = "{\textcopyright} 2020 The Authors. Acta Ophthalmologica published by John Wiley & Sons Ltd on behalf of Acta Ophthalmologica Scandinavica Foundation.",

year = "2020",

month = aug,

doi = "10.1111/aos.14359",

language = "English",

volume = "98",

pages = "485--491",

journal = "Acta Ophthalmologica",

issn = "1755-375X",

publisher = "John Wiley & Sons Inc.",

number = "5",

}

De Clerck, EEB, Schouten, JSAG, Berendschot, TTJM, Koolschijn, RS, Nuijts, RMMA , Schram, MT, Schaper, NC, Henry, RMA , Dagnelie, PC, Ruggeri, A, Guimarães, P, Stehouwer, CDA & Webers, CAB 2020, 'Reduced corneal nerve fibre length in prediabetes and type 2 diabetes: The Maastricht Study', Acta Ophthalmologica, vol. 98, no. 5, pp. 485-491. https://doi.org/10.1111/aos.14359

TY - JOUR

T1 - Reduced corneal nerve fibre length in prediabetes and type 2 diabetes

T2 - The Maastricht Study

AU - De Clerck, Eline E B

AU - Schouten, Jan S A G

AU - Berendschot, Tos T J M

AU - Koolschijn, Renée S

AU - Nuijts, Rudy M M A

AU - Schram, Miranda T

AU - Schaper, Nicolaas C

AU - Henry, Ronald M A

AU - Dagnelie, Pieter C

AU - Ruggeri, Alfredo

AU - Guimarães, Pedro

AU - Stehouwer, Coen D A

AU - Webers, Carroll A B

PY - 2020/8

Y1 - 2020/8

N2 - PURPOSE: In individuals with diabetes, injury to the corneal nerve fibres predisposes to delayed corneal epithelial healing, reduced corneal sensitivity and corneal erosion. We investigated to what extent a reduction in corneal nerve fibre length (CNFL) is present in individuals with prediabetes or type 2 diabetes (DM2) compared with individuals with normal glucose metabolism (NGM).METHODS: Using composite images acquired by corneal confocal microscopy, we assessed total CNFL per mm2 in the subbasal nerve plexus of the cornea in 134 participants (mean age 59 ± 8 years, 49% men, 87 NGM, 20 prediabetes, 27 DM2). Multivariable linear regression was used to assess the association between CNFL and glucose metabolism status, adjusted for age and sex.RESULTS: In individuals with type 2 diabetes, the mean CNFL was significantly reduced [β = -1.86 mm/mm2 (95% CI -3.64 to -0.08), p = 0.04], as compared with individuals with normal glucose metabolism after adjustment for age and sex. Part of the reduction was present in individuals with prediabetes [β = -0.96 mm/mm2 (95% CI -2.91 to 0.99), p = 0.34], with a linear trend of corneal nerve fibre reduction with severity of glucose metabolism status (p trend = 0.04).CONCLUSIONS: A significant reduction in CNFL was found in individuals with DM2 compared with individuals with NGM. A trend of reduction in CNFL was observed between individuals with NGM and prediabetes. The reduction in corneal nerve fibre length could contribute to a delayed corneal healing and an increased risk for corneal complications after surgery.

AB - PURPOSE: In individuals with diabetes, injury to the corneal nerve fibres predisposes to delayed corneal epithelial healing, reduced corneal sensitivity and corneal erosion. We investigated to what extent a reduction in corneal nerve fibre length (CNFL) is present in individuals with prediabetes or type 2 diabetes (DM2) compared with individuals with normal glucose metabolism (NGM).METHODS: Using composite images acquired by corneal confocal microscopy, we assessed total CNFL per mm2 in the subbasal nerve plexus of the cornea in 134 participants (mean age 59 ± 8 years, 49% men, 87 NGM, 20 prediabetes, 27 DM2). Multivariable linear regression was used to assess the association between CNFL and glucose metabolism status, adjusted for age and sex.RESULTS: In individuals with type 2 diabetes, the mean CNFL was significantly reduced [β = -1.86 mm/mm2 (95% CI -3.64 to -0.08), p = 0.04], as compared with individuals with normal glucose metabolism after adjustment for age and sex. Part of the reduction was present in individuals with prediabetes [β = -0.96 mm/mm2 (95% CI -2.91 to 0.99), p = 0.34], with a linear trend of corneal nerve fibre reduction with severity of glucose metabolism status (p trend = 0.04).CONCLUSIONS: A significant reduction in CNFL was found in individuals with DM2 compared with individuals with NGM. A trend of reduction in CNFL was observed between individuals with NGM and prediabetes. The reduction in corneal nerve fibre length could contribute to a delayed corneal healing and an increased risk for corneal complications after surgery.

KW - COMPLICATIONS

KW - CONFOCAL MICROSCOPY

KW - DENSITY

KW - GLUCOSE-TOLERANCE

KW - INNERVATION

KW - NEUROPATHY

KW - OPHTHALMIC MARKERS

KW - PLEXUS

KW - RETINOPATHY

KW - SENSITIVITY

KW - corneal confocal microscopy

KW - corneal nerves

KW - prediabetes

KW - type 2 diabetes

U2 - 10.1111/aos.14359

DO - 10.1111/aos.14359

M3 - Article

C2 - 32017403

SN - 1755-375X

VL - 98

SP - 485

EP - 491

JO - Acta Ophthalmologica

JF - Acta Ophthalmologica

IS - 5

ER -

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

Abstract

Keywords

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