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. 2020 Feb 25;10(1):3371.
doi: 10.1038/s41598-020-60422-7.

Corneal confocal microscopy detects small nerve fibre damage in patients with painful diabetic neuropathy

Alise Kalteniece  1 , Maryam Ferdousi  1 , Shazli Azmi  1 , Womba M Mubita  2 , Andrew Marshall  1 , Giuseppe Lauria  3 , Catharina G Faber  4 , Handrean Soran  1 , Rayaz A Malik  5   6
Affiliations

Corneal confocal microscopy detects small nerve fibre damage in patients with painful diabetic neuropathy

Alise Kalteniece et al. Sci Rep. .

Abstract

Neuropathic pain is believed to arise from damage to nociceptive C fibres in diabetic neuropathy (DN). We have utilised corneal confocal microscopy (CCM) to quantify the severity of small nerve fibre damage in relation to the severity of neuropathic pain and quality of life (QoL) in patients with and without painful DN. 30 controls and patients with painful (n = 78) and painless (n = 62) DN underwent assessment of large and small nerve fibre function, CCM, neuropathic symptoms (small fibre neuropathy symptom inventory questionnaire, neuropathic pain scale) and QoL (SF-36, pre-R-ODS and hospital anxiety and depression scale). Patients with painful compared to painless DN, had comparable neurophysiology and vibration perception, but lower corneal nerve fibre density (20.1 ± 0.87 vs. 24.13 ± 0.91, P = 0.005), branch density (44.4 ± 3.31 vs. 57.74 ± 3.98, P = 0.03), length (19.61 ± 0.81 vs. 22.77 ± 0.83, P = 0.01), inferior whorl length (18.03 ± 1.46 vs. 25.1 ± 1.95, P = 0.005) and cold sensation threshold (21.35 ± 0.99 vs. 26.08 ± 0.5, P < 0.0001) and higher warm sensation threshold (43.7 ± 0.49 vs. 41.37 ± 0.51, P = 0.004) indicative of small fibre damage. There was a significant association between all CCM parameters and the severity of painful neuropathic symptoms, depression score and QoL. CCM identifies small nerve fibre loss, which correlates with the severity of neuropathic symptoms and reduced QoL in patients with painful diabetic neuropathy.

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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 inferior whorl in a healthy control (a,d), patient with painless DN (b,e) and patient with painful DN (c,f).
Figure 2
Figure 2
Dot plots of corneal nerve fiber parameters (mean ± SE): (a) corneal nerve fiber density (CNFD), (b) corneal nerve branch density (CNBD), (c) corneal nerve fiber length (CNFL), (d) inferior whorl length (IWL) in healthy controls and patients with painless and painful DN.
Figure 3
Figure 3
Measures of QoL and pain. (a) Small fibre neuropathy symptom inventory questionnaire (SFN-SIQ) in patients with painful DN; (b) Hospital anxiety depression scale (HADS); (c) preliminary Rasch-built Overall Disability Scale (pre-R-ODS) in patients with painless and painful DN.
See this image and copyright information in PMC

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