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. 2022 Jan 3;11(1):17.
doi: 10.1167/tvst.11.1.17.

Corneal Confocal Microscopy in Type 1 Diabetes Mellitus: A Six-Year Longitudinal Study

Stuti L Misra  1 , James A Slater  1 , Charles N J McGhee  1 , Monika Pradhan  1 , Geoffrey D Braatvedt  2
Affiliations

Corneal Confocal Microscopy in Type 1 Diabetes Mellitus: A Six-Year Longitudinal Study

Stuti L Misra et al. Transl Vis Sci Technol. .

Abstract

Purpose: The current study describes corneal nerve morphology using in vivo confocal microscopy (IVCM) in patients with type 1 diabetes (T1D) who were followed up for 6 years, and it examines the relationship between corneal parameters and metabolic control of glucose and peripheral neuropathy.

Methods: Sixty-two participants (37 with T1D and 25 control participants) were assessed in 2011 and 2017. Participants with bilateral cataract surgery or controls who developed diabetes were excluded. All underwent HbA1c, IVCM, and central corneal sensitivity measurements at both time points in the eye previously examined. A modified total neuropathy score was obtained.

Results: Participants were age and sex matched. The mean duration of diabetes was 32.1 ± 12.0 years at the follow-up visit. The sub-basal nerve density in participants with T1D was lower than that of the controls and did not change (mean ± SD, 11.07 ± 4.0 to 11.41 ± 4.1 mm/mm2; P = 0.71), but it showed a marginal change in controls (19.5 ± 3.7 to 21.63 ± 4.03 mm/mm2; P = 0.06). The corneal sensitivity in T1D did not change (1.3 ± 1.5 to 1.4 ± 1.0 mbar; P = 0.8), and it declined in the controls (0.2 ± 0.3 to 0.6 ± 0.3 mbar; P < 0.001). There were no significant changes in HbA1c (60.5 ± 12.5 to 61.6 ± 13.7 mmol/mol) or in modified total neuropathy scores (2.4 ± 3.2 to 3.4 ± 3.8; P = 0.2).

Conclusions: The corneal nerve damage and poorer corneal sensitivity reported in the patients with T1D did not change and displayed improvement with good glycemic control.

Translational relevance: The corneal nerve changes may be of more value in those with a shorter duration of diabetes for the timely prediction of at-risk individuals likely to develop peripheral neuropathy, particularly in type 1 diabetes.

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Conflict of interest statement

Disclosure: S.L. Misra, None; J.A. Slater, None; C.N.J. McGhee, None; M. Pradhan, None; G.D. Braatvedt, None

Figures

Figure 1.
Figure 1.
Pearson correlation analysis of the change in SBN density versus the change in corneal sensitivity in 37 people with T1D assessed 6 years apart (r = 0.08; P = 0.63).
Figure 2.
Figure 2.
Pearson correlation analysis of the change in SBN versus time-weighted average HbA1c in 37 people with T1D assessed 6 years apart (r = 0.35; P = 0.03).
See this image and copyright information in PMC

References

    1. Messmer EM, Schmid-Tannwald C, Zapp D, Kampik A.. In vivo confocal microscopy of corneal small fiber damage in diabetes mellitus. Graefes Arch Clin Exp Ophthalmol. 248(9): 1307–1312. - PubMed
    1. Misra SL, Craig JP, Patel DV, et al. .. In vivo confocal microscopy of corneal nerves: an ocular biomarker for peripheral and cardiac autonomic neuropathy in type 1 diabetes mellitus. Invest Ophthalmol Vis Sci. 2015; 56(9): 5060–5065. - PubMed
    1. Tavakoli M, Kallinikos P, Iqbal A, et al. .. Corneal confocal microscopy detects improvement in corneal nerve morphology with an improvement in risk factors for diabetic neuropathy. Diabet Med. 2011; 28(10): 1261–1267. - PMC - PubMed
    1. Zhivov A, Winter K, Hovakimyan M, et al. .. Imaging and quantification of subbasal nerve plexus in healthy volunteers and diabetic patients with or without retinopathy. PLoS One. 2013; 8(1): e52157. - PMC - PubMed
    1. Deák EA, Szalai E, Tóth N, Malik RA, Berta A, Csutak A.. Longitudinal changes in corneal cell and nerve fiber morphology in young patients with type 1 diabetes with and without diabetic retinopathy: a 2-year follow-up study. Invest Ophthalmol Vis Sci. 2019; 60(2): 830–837. - PubMed

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