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E. Midena, S. Vujosevic, S. Miotto, M. Cortese, E. Benetti, A. Ghirlando; Monitoring Nerve Regeneration in Corneal Diabetic Neuropathy With Corneal Confocal Microscopy. Invest. Ophthalmol. Vis. Sci. 2008;49(13):2261.
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© ARVO (1962-2015); The Authors (2016-present)
Corneal diabetic neuropathy (CDN) is a hallmark of peripheral diabetic neuropathy. In this study, we investigate corneal subbasal nerve plexus changes in CDN using corneal confocal microscopy .
30 consecutive diabetic patients affected in both eyes by CDN ( subasal plexus nerve changes) were investigated and followed using corneal confocal microscopy (Confoscan4, Nidek, Japan). A new validated technique for subasal nerve plexus detection and examination was applied. Corneal confocal microscopy parameters for nerve changes were: number and density of nerve fibers, nerve tortuosity and branching, number of nerve beadings. Two masked examiners evaluated and quantified corneal confocal microscopy images.
Corneal confocal microscopy allowed in all cases a quantitative analysis of subbasal nerve plexus. Intra and inter-examiner agreement for confocal microscopy images were almost perfect (k= 0.95 and 0.92 , respectively). Significant Increase of nerve beadings (p <0.005) and reduction in nerve tortuosity ( p<0.004) were the distinctive parameters of nerve regeneration. Increase of nerves density and fibers was a late phaenomenon.
These results show that corneal confocal microscopy is the key diagnostic technique in evaluating and monitoring CDN. Quantification of corneal subbasal nerve plexus parameters allows a correct, reproducible and objective, in vivo, non invasive approach to CDN, allowing to characterize peripheral diabetic neuropathay, a potentially highly diasbling complication of diabetes.
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