Corneal Confocal Microscopy in the Diagnosis of Small Fiber Neuropathy: Faster, Easier, and More Efficient Than Skin Biopsy?

Lukashenko, Maria; Gavrilova, Natalia; Bregovskaya, Anna; Сопрун, Лидия; Чурилов, Леонид; Petropoulos, Ioannis N.; Malik, Rayaz A.; Shoenfeld, Yehuda

doi:10.3390/pathophysiology29010001

Cited by 13 publications

(9 citation statements)

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“…In summary, the findings showed with IVCM supported the diagnosis of SFN in the context of neuroborreliosis by Borrellia Miyamotoi, with a comparable sensitivity and specificity to intra-epidermal nerve fiber density in skin biopsies [ 28 , 29 , 38 ], but with the advantage of being a non-invasive technique. In addition, IVCM could be an interesting tool for the follow-up of patients with neuroborreliosis or other SFN and for the evaluation of the efficacy of neurological treatments.…”

Section: Discussionmentioning

confidence: 66%

“…Due to the high density of the corneal innervation, the cornea could be a target for SFN diagnosis. In fact, over the last decade, the quantification of small nerve fiber in the cornea using IVCM has been increasingly used for patients with small fiber dysautonomias [ 28 , 29 ], other peripheral neuropathies, such as diabetes [ 30 ], Charcot Marie Tooth [ 31 ], and multiple sclerosis [ 32 ]. All these conditions are characterized by a decrease in small-fiber density.…”

Section: Discussionmentioning

confidence: 99%

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Corneal Confocal Microscopy Findings in Neuro Lyme Disease: A Case Report

et al. 2022

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Neuro Lyme disease is caused by several bacteriae of the Borreliaceae family, such as Borrelia Miyamotoi. In late stages of illness, patients with Lyme disease may develop chronic neurologic symptoms such as cognitive disturbances or small fiber peripheral neuropathy. Confocal microscopy is a non-invasive method designed to evaluate the human cornea in vivo. Thus, all the corneal layers, including the cells and the sub-basal nerve plexus, can be easily visualized and analyzed. This is the first report of the morphology of small-fiber peripheral neuropathy analyzed by confocal microscopy in a patient diagnosed of neuro Lyme disease. The decrease in the number of unmyelinated sub-basal nerve fibers with abundant presence of dendritic cells (DC) in comparison with healthy corneas strongly supports the diagnosis of small fiber peripheral neuropathy in a case of neuroborreliosis disease.

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Section: Discussionmentioning

confidence: 66%

Section: Discussionmentioning

confidence: 99%

Corneal Confocal Microscopy Findings in Neuro Lyme Disease: A Case Report

et al. 2022

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“…Additionally, IVCM performed in association with PREP examination increased the identification of patients with small fibers impairment to 85% while QST, QSART, and proximal IENFD showed significantly lower impact [ 102 ].…”

Section: Discussionmentioning

confidence: 99%

Corneal Sub-Basal Nerve Plexus in Non-Diabetic Small Fiber Polyneuropathies and the Diagnostic Role of In Vivo Corneal Confocal Microscopy

Roszkowska

Wylęgała

Gargiulo

et al. 2023

JCM

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In vivo corneal confocal microscopy (IVCM) allows the immediate analysis of the corneal nerve quantity and morphology. This method became, an indispensable tool for the tropism examination, as it evaluates the small fiber plexus in the cornea. The IVCM provides us with direct information on the health of the sub-basal nerve plexus and indirectly on the peripheral nerve status. It is an important tool used to investigate peripheral polyneuropathies. Small-fiber neuropathy (SFN) is a group of neurological disorders characterized by neuropathic pain symptoms and autonomic complaints due to the selective involvement of thinly myelinated Aδ-fibers and unmyelinated C-fibers. Accurate diagnosis of SFN is important as it provides a basis for etiological work-up and treatment decisions. The diagnosis of SFN is sometimes challenging as the clinical picture can be difficult to interpret and standard electromyography is normal. In cases of suspected SFN, measurement of intraepidermal nerve fiber density through a skin biopsy and/or analysis of quantitative sensory testing can enable diagnosis. The purpose of the present review is to summarize the current knowledge about corneal nerves in different SFN. Specifically, we explore the correlation between nerve density and morphology and type of SFN, disease duration, and follow-up. We will discuss the relationship between cataracts and refractive surgery and iatrogenic dry eye disease. Furthermore, these new paradigms in SFN present an opportunity for neurologists and clinical specialists in the diagnosis and monitoring the peripheral small fiber polyneuropathies.

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“…5) ha mostrado ser un buen «subrogado» de la biopsia cutánea con buenas correlaciones tanto patológicas como con test funcionales 30,33 . Es un test rápido, analiza in vivo la densidad, ramificaciones y longitud de las diferentes fibras nerviosas del plexo subbasal de la córnea y tiene un buen correlato con los estudios morfológicos de la piel 34 . Hay pocos estudios con esta nueva técnica, pero Figura 1.…”

Section: Métodos Diagnósticosunclassified