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Comparative Study
. 2020 Mar 9;61(3):48.
doi: 10.1167/iovs.61.3.48.

Diabetic Neuropathy Is Characterized by Progressive Corneal Nerve Fiber Loss in the Central and Inferior Whorl Regions

Maryam Ferdousi  1 , Alise Kalteniece  1 , Ioannis Petropoulos  1 , Shazli Azmi  1 , Shaishav Dhage  1 , Andrew Marshall  1 , Andrew J M Boulton  1 , Nathan Efron  1 , Catharina G Faber  1 , Giuseppe Lauria  2 , Handrean Soran  1 , Rayaz A Malik  1   1
Affiliations
Comparative Study

Diabetic Neuropathy Is Characterized by Progressive Corneal Nerve Fiber Loss in the Central and Inferior Whorl Regions

Maryam Ferdousi et al. Invest Ophthalmol Vis Sci. .

Abstract

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.

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Conflict of interest statement

Disclosure: M. Ferdousi, None; A. Kalteniece, None; I. Petropoulos, None; S. Azmi, None; S. Dhage, None; A. Marshall, None; A.J.M. Boulton, None; N. Efron, None; C.G. Faber, None; G. Lauria, None; H. Soran, None; R.A. Malik, None

Figures

Figure 1.
Figure 1.
CCM images of the central cornea (first row) and IW (second row) in a healthy control at baseline (A, E) and follow-up (B, F), and an age-matched patient with diabetes at baseline (C, G) and follow-up (D, H). Scale bar: 50 pixels.
Figure 2.
Figure 2.
(A) CNFL and (B) IWL in patients with diabetes at baseline and follow-up (each dot represents a single patient).
See this image and copyright information in PMC

References

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