Corneal nerves in diabetes—The role of the in vivo corneal confocal microscopy of the subbasal nerve plexus in the assessment of peripheral small fiber neuropathy

Roszkowska, Anna M.; Licitra, Carmelo; Tumminello, Giuseppe; Postorino, Elisa Imelde; Mr, Colonna; Aragona, Pasquale

doi:10.1016/j.survophthal.2020.09.003

Cited by 41 publications

(46 citation statements)

References 123 publications

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“…These metabolic changes complement each other through a complex interplay to cause diabetic neuronal degeneration, which results in diabetic neuropathy [1]. Like other peripheral nerves, DM could also adversely affect corneal nerves [10]. The mechanism of impaired corneal innervation in diabetic individuals is regarded to be the same as the pathogenesis of diabetic neuropathy described below.…”

Section: Pathogenesis Of Diabetic Neuropathy and Diabetic Corneal Neumentioning

confidence: 99%

“…In diabetic patients, the morphological impact of DM on corneal subbasal nerve plexus has been shown to correlate with peripheral nerve fibre changes [1,10]. Further, symptoms and the severity of DPN are linked with progressive loss of corneal nerve fibre density (Section 4.2) [1,32,33].…”

Section: Diabetic Peripheral Neuropathy (Dpn)mentioning

confidence: 99%

“…A reduction of corneal nerve fibre length, nerve fibre density and nerve branch density, as well as an increase in nerve fibre tortuosity, was seen in patients with DM ( Figure 3). Increased tortuosity represents ongoing corneal neuronal degeneration and regeneration during the clinical course of DM [10,77]. Some studies have also reported a significant reduction in nerve beading frequency, indicating reduced metabolic activity and increased risk of neuronal damage in patients with DM [10,78].…”

Section: Corneal Confocal Microscopymentioning

confidence: 99%

“…Increased tortuosity represents ongoing corneal neuronal degeneration and regeneration during the clinical course of DM [10,77]. Some studies have also reported a significant reduction in nerve beading frequency, indicating reduced metabolic activity and increased risk of neuronal damage in patients with DM [10,78]. The nerve fibre length and nerve fibre density of the subbasal inferior whorl of the corneal nerves may also be decreased in DM (Figure 4), presenting as an early manifestation in comparison to the nerve changes in the central cornea.…”

Section: Corneal Confocal Microscopymentioning

confidence: 99%

“…It could be considered as the optimal imaging site in diabetic patients to improve the diagnostic performance of IVCM scans [63,79]. DM [10,77]. Some studies have also reported a significant reduction in nerve beading frequency, indicating reduced metabolic activity and increased risk of neuronal damage in patients with DM [10,78].…”

Section: Corneal Confocal Microscopymentioning

confidence: 99%

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Diabetic keratopathy (DK) is a common, but underdiagnosed, ocular complication of diabetes mellitus (DM) that has a significant economic burden. It is characterised by progressive damage of corneal nerves, due to DM-induced chronic hyperglycaemia and its associated metabolic changes. With advances in corneal nerve imaging and quantitative analytic tools, studies have shown that the severity of diabetic corneal neuropathy correlates with the status of diabetic peripheral neuropathy. The corneal nerve plexus is, therefore, considered as an important surrogate marker of diabetic peripheral neuropathy and helps in the evaluation of interventional efficacy in the management of DM. The clinical manifestations of DK depend on the disease severity and vary from decreased corneal sensitivity to sight-threatening corneal infections and neurotrophic ulcers. The severity of diabetic corneal neuropathy and resultant DK determines its management plan, and a step-wise approach is generally suggested. Future work would focus on the exploration of biomarkers for diabetic corneal neuropathy, the development of new treatment for corneal nerve protection, and the improvement in the clinical assessment, as well as current imaging technique and analysis, to help clinicians detect diabetic corneal neuropathy earlier and monitor the sub-clinical progression more reliably.

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Section: Pathogenesis Of Diabetic Neuropathy and Diabetic Corneal Neumentioning

confidence: 99%