| Abstract |
CORRELATION OF DIABETIC RETINOPATHY AND CORNEAL
NEUROPATHY USING CONFOCAL MICROSCOPY
INTRODUCTION: Diabetes Mellitus is a metabolic disease with increasing interest
both for clinicians and researchers due to the severe complications in several systems.
These have a great impact not only on the psychology and everyday life of diabetic
patients but also on the economy and the health system of each country. Diabetic
retinopathy is the leading cause of blindness and on the other hand, the peripheral
diabetic neuropathy is responsible for a large percentage of amputations. A variety of
techniques have been used for imaging the human cornea, such as optical and electron
in vitro microscopy, slit lamp, confocal and specular biomicroscopy.
OBJECTIVE: Confocal microscopy is a rapid, non-invasive and reiterative technique
of imaging the human cornea, suitable for the accurate detection and quantification of
the sub-basal nerve plexus. The aim of this study is to correlate corneal nerve fibre
alterations with the abnormalities in the retina of diabetic patients and compare them
with those of non-diabetic patients. This simultaneous assessment of both
complications could also reveal a common clinical evaluation and pathogenic
mechanism.
METHODS: Two hundred seventy eight corneas of 139 diabetic patients and 94
corneas of 47 control subjects, of similar age (62.8 ± 8 years, mean ± SD) were
examined in this study. Diabetic patients were further classified with respect to the
presence or not and the level of retinopathy, according to the findings of indirect
fundoscopy, fundus photography and fluorescein angiography. The central corneas
Σελίδα 5
were scanned with corneal confocal microscopy and we estimated subabasal nerve
plexus, calculating the nerve fibre density, nerve branch density, nerve fibre length
and nerve fibre tortuosity. The glycemic and lipidemic profile of diabetic patients
were also determined.
RESULTS: Nerve fibre density, branch density and length were all found to be
significantly reduced, whereas nerve fibre tortuosity was found to be significantly
higher, in diabetic patients compared to control subjects. Nerve fibre alterations
among diabetic patients were consistent with the diabetic retinopathy level. Diabetic
corneal neuropathy seems to deteriorate along with the glycemic profile of patients,
whereas their lipidemic profile varies.
CONCLUSIONS: Nerve fibre alterations of the sub-basal plexus of diabetic corneas
appear to have a common progression with diabetic retinopathy. In addition, they
seem to be influenced by blood glucose concentrations. Corneal confocal microscopy
could possibly represent a promising technique for the early diagnosis and treatment
of diabetic neuropathy.
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Συσχέτιση της διαβητικής αμφιβληστροειδοπάθειας και κερατοπάθειας με τη βοήθεια της ομοεστιακής μικροσκοπίας
