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. 2018 Feb 19;8(1):3283.
doi: 10.1038/s41598-018-21643-z.

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

Alise Kalteniece  1 , Maryam Ferdousi  1 , Ioannis Petropoulos  2 , Shazli Azmi  1 , Safwaan Adam  1 , Hassan Fadavi  1 , Andrew Marshall  1 , Andrew J M Boulton  1 , Nathan Efron  3 , Catharina G Faber  4 , Giuseppe Lauria  5   6 , Handrean Soran  1 , Rayaz A Malik  7   8
Affiliations

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

Alise Kalteniece et al. Sci Rep. .

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 ~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.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
CCM images of the central cornea and IW in control subject (a and b), in a patient with DN− (c and d) and in a patient with DN+ (e and f).
Figure 2
Figure 2
Error bar plots for corneal nerve fibre density (CNFD) (a), corneal nerve branch density (CNBD) (b), corneal nerve fibre length (CNFL) (c), Inferior whorl length (IWL) (d), average nerve fibre length (ANFL) (e) and total nerve fibre length (TNFL) (f) in controls and diabetic patients without (DN−) and with (DN+) neuropathy.
Figure 3
Figure 3
The association between inferior whorl length (IWL) and corneal nerve fibre length (CNFL).
See this image and copyright information in PMC

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