Journal Article

Corneal nerve loss in children with type 1 diabetes mellitus without retinopathy or microalbuminuria

Petrovski, Goran, Shamekh, Ahmed, Ponirakis, Georgios, Elawad, Mamoun, Abdelrahman, Hatim, Saraswathi, Saras, Akobeng, Anthony K, Malik, Rayaz A, Almasri, Wesam, Elawwa, Ahmed, Hendaus, Mohamed A, Khan, Adnan, Al‐Jarrah, Bara, Khalifa, Amel, Al Maadheed, Maryam, Al Zyoud, Mahmoud, Singh, Parul, Gad, Hoda, Al‐Khalaf, Fawziya, Hussain, Khalid, Petropoulos, Ioannis N, Al Khodor, Souhaila

2020

Overview

Aims/Introduction Corneal confocal microscopy is a rapid, non‐invasive ophthalmic technique to identify subclinical neuropathy. The aim of this study was to quantify corneal nerve morphology in children with type 1 diabetes mellitus compared with age‐matched healthy controls using corneal confocal microscopy. Materials and Methods A total of 20 participants with type 1 diabetes mellitus (age 14 ± 2 years, diabetes duration 4.08 ± 2.91 years, glycated hemoglobin 9.3 ± 2.1%) without retinopathy or microalbuminuria and 20 healthy controls were recruited from outpatient clinics. Corneal confocal microscopy was undertaken, and corneal nerve fiber density (n/mm2), corneal nerve branch density (n/mm2), corneal nerve fiber length (mm/mm2), corneal nerve fiber tortuosity and inferior whorl length (mm/mm2) were quantified manually. Results Corneal nerve fiber density (22.73 ± 8.84 vs 32.92 ± 8.59; P < 0.001), corneal nerve branch density (26.19 ± 14.64 vs 47.34 ± 20.01; P < 0.001), corneal nerve fiber length (13.26 ± 4.06 vs 19.52 ± 4.54; P < 0.001) and inferior whorl length (15.50 ± 5.48 vs 23.42 ± 3.94; P < 0.0001) were significantly lower, whereas corneal nerve fiber tortuosity (14.88 ± 5.28 vs 13.52 ± 3.01; P = 0.323) did not differ between children with type 1 diabetes mellitus and controls. Glycated hemoglobin correlated with corneal nerve fiber tortuosity (P < 0.006) and aspartate aminotransferase correlated with corneal nerve fiber density (P = 0.039), corneal nerve branch density (P = 0.003) and corneal nerve fiber length (P = 0.037). Conclusion Corneal confocal microscopy identifies significant subclinical corneal nerve loss, especially in the inferior whorl of children with type 1 diabetes mellitus without retinopathy or microalbuminuria. This is the first study showing significant corneal nerve loss in the central cornea and inferior whorl, indicative of early subclinical neuropathy in children with type 1 diabetes mellitus without microalbuminuria or retinopathy.

• Publisher: John Wiley & Sons, Inc,John Wiley and Sons Inc,Wiley
• Subject: Adolescent / Age / Albuminuria / Aspartate aminotransferase / Biomarkers - analysis / Blood Glucose - analysis / Body mass index / Case-Control Studies / Child / Children / Confocal microscopy / Cornea / Cornea - innervation / Corneal Diseases - epidemiology / Corneal Diseases - etiology / Corneal Diseases - pathology / Cross-Sectional Studies / Diabetes / Diabetes mellitus (insulin dependent) / Diabetes Mellitus, Type 1 - complications / Diabetic Neuropathies - epidemiology / Diabetic Neuropathies - etiology / Diabetic Neuropathies - pathology / Diabetic neuropathy / Diabetic Retinopathy / Female / Follow-Up Studies / Glycated Hemoglobin A - analysis / Hemoglobin / Humans / Laboratories / Male / Microscopy / Original / Prognosis / Retinopathy / Small fiber neuropathy / Systemic diseases / Type 1 diabetes mellitus / United Kingdom - epidemiology / Vitamin D