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M. Papadia, E. Fiorina, R. Scotto, A. Bagnis, A. Schenone, C. E. Traverso; Confocal Microscopy in Patients With Peripheral Neuropathies. Invest. Ophthalmol. Vis. Sci. 2010;51(13):5671.
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Confocal microscopy can be used to analyze in vivo the layers of cornea and conjunctiva.Confocal images are comparable to biopsies, making it possible to study the anatomical changes of the structures. Confocal microscopy can be used to obtain sequential images of the corneal sub-basal nerve plexus and thus detect changes in corneal innervations. To describe changes in corneal sub-basal nerve plexus in patients affected by peripheral neuropathies.
We analyzed the cornea of 20 patients affected by various peripheral neuropthies and of 20 age-matched controls. 8 patients were affected by chronic inflammatory demyelinating neuropathies(CIPD), 5 by hereditary neuropathies, 3 by anti-myelin associated glycoprotein (anti-MAG) neuropathy , 4 by miscellaneous neuropathies. After acquisition the images were analyzed in a blind manner by the operator.
Dendritic cells were identified in12 patients affected by peripheral neuropathies and only in 4 healthy controls. The mean sub-basal nerve plexus density was 7,4 fibers/mm2 in patients affected by polineuropathies and 12,3 fibers/mm2 in healthy controls. This difference was statistically significant (p < 0,001). The grade of tortuosity was higher in the study group compared to controls (respectively grade 2,8 and grade 1,4) while the number of beadings were reduced in the group of patients affected by polineuropathies (88 beads/mm2) compared to the group of controls (189 beads/mm2). There was no statistical difference in the epithelial cell density and keratocyte density between the two groups.
Corneal confocal microscopy is a rapid, non invasive in vivo clinical examination technique which can assess the presence of corneal nerve damage. This technique might become a tool for a non-invasive assessment of nerve damage and therapeutic efficacy in clinical trials.
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