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M. Popper, M.J. Quadrado, A.M. Morgado, J.N. Murta, J.A. Van Best, L.J. Muller; Subbasal Nerves and Highly Reflective Cells in Corneas of Diabetic Patients: In vivo Evaluation by Confocal Microscopy . Invest. Ophthalmol. Vis. Sci. 2005;46(13):879.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To evaluate in vivo changes in density and morphology of subbasal nerves (SBN) and highly reflective cells (HRC) in corneas of diabetic patients with mild and moderate diabetic retinopathy. Methods: The left cornea of 20 type 2 diabetic patients, 10 with mild (level 20 ETDRS) and 10 with moderate (level 35 ETDRS) retinopathy and 10 age–matched healthy controls were examined with the Tomey Confoscan P4 scanning–slit confocal microscope. Through focus scans were recorded from epithelium to endothelium. Images in the epithelium and anterior stroma were analyzed in a masked fashion by two of the authors. Results: The average number of SBN per image for level 20 (1.25 ± 0.52; mean ± SD) and level 35 (1.22 ± 0.60) diabetic patients was about equal (p=0.996) but was significantly lower than that in healthy controls (3.90 ± 1.13; p<0.001). The density of basal epithelial cells in level 20 (5145 ± 237 cells/mm2) and in level 35 (5042 ± 236 cells/mm2) diabetics did not differ significantly (p=0.6). Similar to the SBN, the number of basal epithelial cells was significantly lower than that in healthy controls (5648 ± 236 cells/mm2; p<0.001). Furthermore, very highly reflective cells were observed immediately beneath the basal epithelial cells’ layer. In contrast to the decrease in the number of SBN and of basal epithelial cells, the number of HRC was significantly higher both in level 20 (2.36 ± 1.12) and level 35 (3.10 ± 0.97) diabetics than in healthy controls (1.13 ± 0.72; p<0.02). Conclusions: The decrease in the number of SBN and of basal epithelial cells in the corneas of diabetic patients is characteristic of the disease and these changes might be related to each other. Since the morphology of HRC differs from keratocyte nuclei, and the HRC are located in close vicinity of subbasal nerves, we consider them as dendritic cells.
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