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Corneal confocal microscopy detects small nerve fibre damage in patients with painful diabetic neuropathy.

ABSTRACT: Neuropathic pain is believed to arise from damage to nociceptive C fibres in diabetic neuropathy (DN). We have utilised corneal confocal microscopy (CCM) to quantify the severity of small nerve fibre damage in relation to the severity of neuropathic pain and quality of life (QoL) in patients with and without painful DN. 30 controls and patients with painful (n?=?78) and painless (n?=?62) DN underwent assessment of large and small nerve fibre function, CCM, neuropathic symptoms (small fibre neuropathy symptom inventory questionnaire, neuropathic pain scale) and QoL (SF-36, pre-R-ODS and hospital anxiety and depression scale). Patients with painful compared to painless DN, had comparable neurophysiology and vibration perception, but lower corneal nerve fibre density (20.1?±?0.87 vs. 24.13?±?0.91, P?=?0.005), branch density (44.4?±?3.31 vs. 57.74?±?3.98, P?=?0.03), length (19.61?±?0.81 vs. 22.77?±?0.83, P?=?0.01), inferior whorl length (18.03?±?1.46 vs. 25.1?±?1.95, P?=?0.005) and cold sensation threshold (21.35?±?0.99 vs. 26.08?±?0.5, P?

SUBMITTER: Kalteniece A

PROVIDER: S-EPMC7042367 | biostudies-literature | 2020 Feb

REPOSITORIES: biostudies-literature

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Corneal confocal microscopy detects small nerve fibre damage in patients with painful diabetic neuropathy.

Kalteniece Alise A Ferdousi Maryam M Azmi Shazli S Mubita Womba M WM Marshall Andrew A Lauria Giuseppe G Faber Catharina G CG Soran Handrean H Malik Rayaz A RA

Scientific reports 20200225 1

Neuropathic pain is believed to arise from damage to nociceptive C fibres in diabetic neuropathy (DN). We have utilised corneal confocal microscopy (CCM) to quantify the severity of small nerve fibre damage in relation to the severity of neuropathic pain and quality of life (QoL) in patients with and without painful DN. 30 controls and patients with painful (n = 78) and painless (n = 62) DN underwent assessment of large and small nerve fibre function, CCM, neuropathic symptoms (small fibre neuro ...[more]

PMID: 32099076

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Project description:IntroductionThe assessment of the corneal nerve fibre plexus with corneal confocal microscopy (CCM) is an upcoming but still experimental method in the diagnosis of early stage diabetic peripheral neuropathy (DPN). Using an innovative imaging technique-Heidelberg Retina Tomograph equipped with the Rostock Cornea Module (HRT-RCM) and EyeGuidance module (EG)-we were able to look at greater areas of subbasal nerve plexus (SNP) in order to increase the diagnostic accuracy. The aim of our study was to evaluate the usefulness of EG instead of single image analysis in diagnosis of early stage DPN.MethodsThis prospective study was performed on 60 patients with type 2 diabetes mellitus, classified equally into two subgroups based on neuropathy deficient score (NDS): patients without DPN (group 1) or with mild DPN (group 2). The following parameters were analysed in the two subgroups: corneal nerve fibre length (CNFL; mm/mm2), corneal nerve fibre density (CNFD; no./mm2), corneal nerve branch density (CNBD; no./mm2). Furthermore, we compared the data calculated with the novel mosaic, EG-based method with those received from single image analysis using different quantification tools.ResultsUsing EG we did not find a significant difference between group 1 and group 2: CNFL (16.81 ± 5.87 mm/mm2 vs. 17.19 ± 7.19 mm/mm2, p = 0.895), CNFD (254.05 ± 115.36 no./mm2 vs. 265.91 ± 161.63 no./mm2, p = 0.732) and CNBD (102.68 ± 62.28 no./mm2 vs. 115.38 ± 96.91 no./mm2, p = 0.541). No significant difference between the EG method of analysing the SNP and the single image analysis of 10 images per patient was detected.ConclusionOn the basis of our results it was not possible to differentiate between early stages of large nerve fibre DPN in patients with type 2 diabetes mellitus via SNP analysis. To improve sensitivity and specificity of this method newer technologies are under current evaluation.Trial registrationClinicalTrials.gov Identifier NCT05326958.

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Corneal confocal microscopy detects small nerve fibre damage in patients with painful diabetic neuropathy.

Publications

Corneal confocal microscopy detects small nerve fibre damage in patients with painful diabetic neuropathy.

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