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Maria E. Rosenberg, Timo M. T. Tervo, Ilkka J. Immonen, Linda J. Müller, Carola Grönhagen–Riska, Minna H. Vesaluoma; Corneal Structure and Sensitivity in Type 1 Diabetes Mellitus. Invest. Ophthalmol. Vis. Sci. 2000;41(10):2915-2921. doi: https://doi.org/.
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purpose. Corneal wound healing is impaired in diabetic cornea. The purpose of
this study was to examine patients with type 1 diabetes mellitus for
changes in corneal morphology and to correlate corneal sensitivity,
subbasal nerve morphology, and degree of polyneuropathy with each
methods. Forty-four eyes of 23 patients with diabetes and nine control eyes were
included. Corneal sensitivity was tested with a Cochet–Bonnet
esthesiometer (Luneau, Paris, France), and corneal morphology
and epithelial and corneal thickness were determined by in vivo
confocal microscopy. The density of subbasal nerves was evaluated by
calculating the number of long subbasal nerve fiber bundles per
confocal microscopic field. The degree of polyneuropathy was evaluated
using the clinical part of the Michigan Neuropathy Screening Instrument
(MNSI) classification, and retinopathy was evaluated using fundus
results. A reduction of long nerve fiber bundles per image was noted to have
occurred already in patients with mild to moderate neuropathy, but
corneal mechanical sensitivity was reduced only in patients with severe
neuropathy. Compared with control subjects the corneal thickness was
increased in patients with diabetes without neuropathy. The epithelium
of patients with diabetes with severe neuropathy was significantly
thinner than that of patients with diabetes without neuropathy.
conclusions. Confocal microscopy appears to allow early detection of beginning
neuropathy, because decreases in nerve fiber bundle counts precede
impairment of corneal sensitivity. Apparently, the cornea becomes
thicker in a relatively early stage of diabetes but does not further
change with the degree of neuropathy. A reduction in neurotrophic
stimuli in severe neuropathy may induce a thin epithelium that may lead
to recurrent erosions.
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