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L. Sabato, L. Bertazzi, M. Pellegrini, S. V. Luccarelli, L. Meroni, G. Staurenghi; In vivo Confocal Microscopy of Corneal Nerve Fibres in Hiv+ Patients. Invest. Ophthalmol. Vis. Sci. 2008;49(13):2804.
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To relieve differences in the corneal sub-basal nerve plexus between HIV+ and HIV- patients, using corneal confocal microscopy. Nerve Fibre Lenght (NFL) was assumed as an index to evaluate the compromise of the peripheral nervous system.
We scanned the cornea from both eyes of 20 HIV+ patients and 20 HIV- patients and collected images of the nerve plexus contained in the Bowman’s layer.Corneal confocal laser scanning microscopy was performed using a Rodstock Cornea Module attached to a Heidelberg Retina Tomograph II.2 images per eye were analyzed, using a custom software program, to determine NFL (total nerve lenght [µm] within a confocal image [area = 160000 µm²]).Inclusion criteria were HIV seropositivity, being on highly active antiretroviral therapy (HAART), age 25-65 years, CD4+ T lymphocytes < 500/ microL. Exclusion criteria were diabetes, neuropathies other then DSP, chronic renal failure, Sjogren’s sindrome, connective disorders, corneal pathology, previous eye surgery.
Corneal Nerve Fibre Lengh (µm/µm2) was reduced in HIV+ patients (0.0194, SD=0.047) compared with HIV- patients (0.0236, SD=0.034).NFL was significantly different among the two groups (0.042, 95% CI of mean 0.024-0.060, p<0.001, t test).
The results suggest that HIV+ patients show alterations in corneal innervations consisting in Nerve Fibre Lenght reduction.All HIV+patients in our study had a reduced NFL, even if only 3 of them had clinical diagnosis of DSP, confirmed by electromyography.Corneal confocal microscopy is a rapid, non-invasive in vivo clinical examinationtechnique, that could act as a surrogate measure of distal neuropathy in HIV+ patients.Further prospective clinical studies are needed to evaluate a larger number of patients and a long-term follow up.
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