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Sabine Peschel, Andrey Zhivov, Hans-Christof Schober, Oliver Stachs, Marie Therese Bambi, Ngoy Kilangalanga, Karsten Winter, Rudolf Guthoff; Diabetic Foot Syndrome and Changes of Corneal Subbasal Nerve Plexus in Diabetes Type 2 Congolese Patients. Invest. Ophthalmol. Vis. Sci. 2013;54(15):3578.
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to study the Subbasal Nerve Plexus (SNP)-changes in type 2 diabetic congolese patients and compare it with the severity of diabetic neuropathy, diabetic retinopathy and grades of diabetic foot syndrome.
Patients were recruited in diabetic care unit in a sub-Saharan megacity (Kinshasa, The Democratic Republic of the Congo). Corneal SNP was investigated using confocal laser scanning microscopy (CLSM) analyzing nerve fiber density [mm/mm2], number of branches [n] and number of connectivity points [n]. Foot ulceration was graded by Wagner ulcer classification for diabetic foot syndrome. Corneal sensitivity using Cochet-Bonnet aesthesiometer, Neuropathy Symptom Score (NSS), Neuropathy Disability Score (NDS), ABI (ankle-brachial index) and ophthalmological status were also evaluated.
28 patients with diabetes-related foot ulcerations (12 male, 16 female, aged 59±8.1 yrs., duration of diabetes mellitus 13.4±7.4 yrs, HbA1c 9.9±3.6%) were evaluated. The patients were ranked in Wagner 0-1 (mild manifestations, 46.4%), Wagner 2-3 (moderate, 35.7%) and Wagner 4-5 (severe, 17.9%). Significant differences were observed between Wagner 0-1 and Wagner 4-5 in confocal parameters of SNP (number of branches (p=0.012), number of connectivity points (p=0.001), nerve fibre density (p=0.033)) and ABI (p=0.030) as well as between Wagner 2-3 and Wagner 4-5 in confocal parameters (number of branches (p=0.003), number of connectivity points (p=0.005) and nerve fibre density (p=0.014)).The changes of NDS (p=0.001) and corneal sensation (p=0.032) were significant between Wagner 0-1 and Wagner 2-3. The patients with diabetic retinopathy have significantly higher diabetes duration (p=0.03) and NDS score (p=0.01); there was no difference in SNP morphology or corneal sensation.
this study confirms the diabetic etiology of foot ulceration due to mediasclerosis. It also indicates that grade of diabetic foot syndrome correlates with corneal nerve changes and corneal sensation in patients in sub-Saharan Africa.
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