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. 2021 May 3;62(6):5.
doi: 10.1167/iovs.62.6.5.

Small Nerve Fiber Damage and Langerhans Cells in Type 1 and Type 2 Diabetes and LADA Measured by Corneal Confocal Microscopy

Luca D'Onofrio  1 , Alise Kalteniece  2 , Maryam Ferdousi  2 , Shazli Azmi  2 , Ioannis N Petropoulos  3 , Georgios Ponirakis  3 , Uazman Alam  4 , Omar Asghar  2 , Andrew Marshall  4 , Andrew J M Boulton  2 , Nathan Efron  5 , Raffaella Buzzetti  1 , Handrean Soran  2 , Rayaz A Malik  2   3
Affiliations

Small Nerve Fiber Damage and Langerhans Cells in Type 1 and Type 2 Diabetes and LADA Measured by Corneal Confocal Microscopy

Luca D'Onofrio et al. Invest Ophthalmol Vis Sci. .

Abstract

Purpose: Increased corneal and epidermal Langerhans cells (LCs) have been reported in patients with diabetic neuropathy. The aim of this study was to quantify the density of LCs in relation to corneal nerve morphology and the presence of diabetic neuropathy and to determine if this differed in patients with type 1 diabetes mellitus (T1DM), type 2 diabetes mellitus (T2DM), and latent autoimmune diabetes of adults (LADA).

Methods: Patients with T1DM (n = 25), T2DM (n = 36), or LADA (n = 23) and control subjects (n = 23) underwent detailed assessment of peripheral neuropathy and corneal confocal microscopy. Corneal nerve fiber density (CNFD), branch density (CNBD), length (CNFL) and total, immature and mature LC densities were quantified.

Results: Lower CNFD (P < 0.001), CNBD (P < 0.0001), and CNFL (P < 0.0001) and higher LC density (P = 0.03) were detected in patients with T1DM, T2DM, and LADA compared to controls. CNBD was inversely correlated with mature (r = -0.5; P = 0.008), immature (r = -0.4; P = 0.02) and total (r = -0.5; P = 0.01) LC density, and CNFL was inversely correlated with immature LC density (r = -0.4; P = 0.03) in patients with T1DM but not in patients with T2DM and LADA.

Conclusions: This study shows significant corneal nerve loss and an increase in LC density in patients with T1DM, T2DM, and LADA. Furthermore, increased LC density correlated with corneal nerve loss in patients with T1DM.

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Conflict of interest statement

Disclosure: L. D'Onofrio, None; A. Kalteniece, None; M. Ferdousi, None; S. Azmi, None; I.N. Petropoulos, None; G. Ponirakis, None; U. Alam, None; O. Asghar, None; A. Marshall, None; A.J.M. Boulton, None; N. Efron, None; R. Buzzetti, None; H. Soran, None; R.A. Malik, None

Figures

Figure 1.
Figure 1.
CCM images of a healthy control (A) and age-matched patient with T1DM (B), LADA (C), and T2DM (D).
Figure 2.
Figure 2.
Immature LC density (A), mature LC density (B), and total LC density (C) in controls and patients with T1DM, LADA, or T2DM.
See this image and copyright information in PMC

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