1
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Chu L, Wang C, Zhou H. Inflammation mechanism and anti-inflammatory therapy of dry eye. Front Med (Lausanne) 2024; 11:1307682. [PMID: 38420354 PMCID: PMC10899709 DOI: 10.3389/fmed.2024.1307682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 01/14/2024] [Indexed: 03/02/2024] Open
Abstract
Dry eye is a widespread chronic inflammatory disease that causes fatigue, tingling, burning, and other symptoms. Dry eye is attributed to rheumatic diseases, diabetes, hormone disorders, and contact lenses, which activate inflammatory pathways: mitogen-activated protein kinases (MAPK) and nuclear factor-B (NF-κB), promote macrophage inflammatory cell and T cell activation, and inflammation factors. Clinicians use a combination of anti-inflammatory drugs to manage different symptoms of dry eye; some of these anti-inflammatory drugs are being developed. This review introduces the dry eye inflammation mechanisms and the involved inflammatory factors. We also elucidate the anti-inflammatory drug mechanism and the detection limits.
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Affiliation(s)
- Liyuan Chu
- Department of Ophthalmology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Caiming Wang
- Department of Ophthalmology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Hongyan Zhou
- Department of Ophthalmology, China-Japan Union Hospital of Jilin University, Changchun, China
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2
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Chen D, Wang L, Guo X, Zhang Z, Xu X, Jin ZB, Liang Q. Evaluation of Limbal Stem Cells in Patients With Type 2 Diabetes: An In Vivo Confocal Microscopy Study. Cornea 2024; 43:67-75. [PMID: 37399570 DOI: 10.1097/ico.0000000000003334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Indexed: 07/05/2023]
Abstract
PURPOSE This study aimed to investigate corneal limbus changes in patients with type 2 diabetes mellitus (DM) using in vivo confocal microscopy (IVCM) and explore the correlation between their ocular manifestations and systemic status. METHODS Fifty-five patients with type 2 DM and 20 age-matched controls were included. The following IVCM parameters were compared between the 2 groups: palisades of Vogt (POV), corneal epithelial thickness (CET), basal cell density (BCD), subbasal nerve plexus, and dendritic cell density. All subjects underwent blood and urine sampling for laboratory analysis, including fasting blood glucose, glycated hemoglobin, total cholesterol (TC), triglycerides (TG), low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, C-reactive protein, urinary albumin-to-creatinine ratio, urine albumin, and urine creatinine. The correlations between IVCM parameters and blood biomarkers were detected. Receiver operating characteristic curve was used for selecting the cutoff value of risk factors for corneal stem cell injury in patients with DM. RESULTS Compared with controls, patients with DM displayed a significant reduction of POV (superior region, P = 0.033; inferior region, P = 0.003; nasal region, P < 0.001; temporal region, P < 0.001), central CET (44.8 ± 3.6 μm vs. 51.9 ± 3.6 μm, P < 0.001), central corneal BCD (7415.5 ± 563.2 cells/mm 2 vs. 9177.9 ± 977.8 cells/mm 2 , P < 0.001), and peripheral corneal BCD (6181.3 ± 416.5 cells/mm 2 vs. 8576.3 ± 933.2 cells/mm 2 , P < 0.001). Dendritic cell density (41.0 ± 33.7 cells/mm 2 vs. 24.6 ± 7.8 cells/mm 2 , P = 0.001) was significantly higher in the DM group. The following weak correlations were shown between IVCM parameters and blood biomarkers: central corneal BCD was negatively correlated with DM duration (r = -0.3, P = 0.024), TC (r = -0.36, P = 0.007), and LDL (r = -0.39, P = 0.004). The presence of POV in the superior region was negatively correlated with TC (r = -0.34, P = 0.011) and LDL (r = -0.31, P = 0.022). Cutoff values of 1.215 mmol/L for HDL, 1.59 mmol/L for TG, or 4.75 mmol/L for TC were established to distinguish patients with a high risk from a low risk for stem cell damage. CONCLUSIONS Patients with type 2 DM displayed a lower positive rate of typical POV and a decrease in BCD, CET, and subbasal nerve density. The most relevant indicators for stem cell phenotypes were DM duration, TC, and LDL. Lipid status in diabetic patients could be a predictor of risk for developing corneal limbal stem cell deficiency. Further studies with larger sample sizes or basic research are needed to verify the results.
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Affiliation(s)
- Dan Chen
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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3
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Banerjee M, Mukhopadhyay P, Ghosh S, Basu M, Pandit A, Malik R, Ghosh S. Corneal Confocal Microscopy Abnormalities in Children and Adolescents With Type 1 Diabetes. Endocr Pract 2023; 29:692-698. [PMID: 37343765 DOI: 10.1016/j.eprac.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 06/09/2023] [Accepted: 06/13/2023] [Indexed: 06/23/2023]
Abstract
OBJECTIVE Utility of corneal confocal microscopy (CCM) in children and adolescents with type 1 diabetes mellitus (T1DM) without neuropathic symptoms or signs and minimal abnormality in large and small nerve fiber function tests remains largely undetermined. This study aimed to evaluate the performance of CCM in comparison to thermal detection thresholds (TDT) testing and nerve conduction studies (NCS) for detecting neuropathy in children with T1DM. METHODS A cohort of children and adolescents with T1DM (n = 51) and healthy controls (n = 50) underwent evaluation for symptoms and signs of neurological deficits, including warm detection threshold, cold detection threshold, vibration perception threshold, NCS, and CCM. RESULTS Children with T1DM had no or very minimal neuropathic symptoms and deficits based on the Toronto Clinical Neuropathy Score, yet NCS abnormalities were present in 18 (35%), small fiber dysfunction defined by an abnormal TDT was found in 13 (25.5%) and CCM abnormalities were present in 25 (49%). CCM was abnormal in a majority of T1DM children with abnormal TDT (12/13, 92%) and abnormal NCS (16/18, 88%). CCM additionally was able to detect small fiber abnormalities in 13/38 (34%) in T1DM with a normal TDT and in 9/33 (27%) with normal NCS. CONCLUSION CCM was able to detect corneal nerve loss in children with and without abnormalities in TDT and NCS.
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Affiliation(s)
- Mainak Banerjee
- Department of Endocrinology, Senior Resident, Institute of Post Graduate Medical Education & Research, Kolkata, India
| | - Pradip Mukhopadhyay
- Department of Endocrinology, Institute of Post Graduate Medical Education & Research, Kolkata, India
| | - Shatabdi Ghosh
- Department of Endocrinology, Institute of Post Graduate Medical Education & Research, Kolkata, India
| | - Madhurima Basu
- Department of Endocrinology, Institute of Post Graduate Medical Education & Research, Kolkata, India
| | - Alak Pandit
- Department of Neurology, Bangur Institute of Neurology, Kolkata, India
| | - Rayaz Malik
- Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar; Division of Cardiovascular Sciences, Cardiac Centre, Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom
| | - Sujoy Ghosh
- Department of Endocrinology, Institute of Post Graduate Medical Education & Research, Kolkata, India.
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4
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Pacaud D, Romanchuk KG, Virtanen H, Ferdousi M, Nettel-Aguirre A, Mah JK, Tavakoli M, Zochodne DW, Malik RA. Corneal nerve and nerve conduction abnormalities in children with type 1 diabetes. Pediatr Diabetes 2022; 23:1665-1673. [PMID: 36131228 DOI: 10.1111/pedi.13419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 09/08/2022] [Accepted: 09/17/2022] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE In vivo corneal confocal microscopy (CCM) is a novel, rapid, and non-invasive technique that identifies early small fiber damage and can predict the progression and development of clinical neuropathy in adults with type 1 diabetes. However, its usefulness in children is not well established. This study compared corneal confocal microscopy with neuropathic symptoms, signs, and objective measures of neuropathy for the diagnosis of diabetic neuropathy in children with type 1 diabetes. RESEARCH DESIGN AND METHODS A total of 83 children with type 1 diabetes and 83 healthy participants of similar age underwent assessment of neuropathy symptoms, signs, nerve conduction studies, quantitative sensory and autonomic function testing, and in vivo CCM. RESULTS Only of 3/83 (4%) children with type 1 diabetes had subclinical neuropathy. However, corneal nerve fiber density (p = 0.001), branch density (p = 0.006), fiber length (p = 0.002), tibial motor nerve amplitude and conduction velocity, and sural sensory nerve amplitude and conduction velocity (all p < 0.004) were lower in participants with type 1 diabetes than in the controls. Vibration, cooling, and warm perception thresholds and deep breathing heart rate variability were not found to be different (all p > 0.05) between children with type 1 diabetes and healthy controls. Multivariate regression analysis identified a possible association between body mass index and decreased corneal nerves. CONCLUSIONS Decreased corneal nerves and abnormal nerve conduction were found in children with type 1 diabetes. CCM may allow rapid objective detection of subclinical diabetic neuropathy in children and adolescents with type 1 diabetes.
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Affiliation(s)
- Danièle Pacaud
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Pediatric Diabetes, Pediatric Neurology and Pediatric Ophthalmology divisions, Alberta Children's Hospital, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | - Kenneth G Romanchuk
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Pediatric Diabetes, Pediatric Neurology and Pediatric Ophthalmology divisions, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Heidi Virtanen
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Pediatric Diabetes, Pediatric Neurology and Pediatric Ophthalmology divisions, Alberta Children's Hospital, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | - Maryam Ferdousi
- Division of Cardiovascular Sciences, Cardiac Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,NIHR/Wellcome Trust Clinical Research Facility, Manchester, UK
| | - Alberto Nettel-Aguirre
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Centre for Health and Social Analytics, NIASRA, University of Wollongong, Wollongong, New South Wales, Australia
| | - Jean K Mah
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Pediatric Diabetes, Pediatric Neurology and Pediatric Ophthalmology divisions, Alberta Children's Hospital, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | - Mitra Tavakoli
- Centre for Endocrinology and Diabetes, Institute of Human Development, University of Manchester, Manchester, UK.,Exeter Centre of Excellence for Diabetes Research, NIHR Exeter Clinical Research Facility, University of Exeter Medical School, Exeter, UK
| | - Douglas W Zochodne
- Division of Neurology, Department of Medicine and the Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Rayaz A Malik
- Division of Cardiovascular Sciences, Cardiac Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,NIHR/Wellcome Trust Clinical Research Facility, Manchester, UK.,Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
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5
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Zhang Z, Lu S, Jiang Y, Sun S. Assessing the corneal sub-basal nerve plexus by in vivo confocal microscopy in patients with blepharoptosis. Ann Med 2022; 54:227-234. [PMID: 35014936 PMCID: PMC8757600 DOI: 10.1080/07853890.2021.2024246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND To assess in vivo confocal microscopy features of corneal sub-basal nerve plexus in patients with congenital or aponeurogenic blepharoptosis using a fully automated software (ACCMetrics). PATIENTS AND METHODS This prospective study included 33 patients with blepharoptosis and 17 normal controls. The corneal sub-basal nerve plexus was assessed using in vivo confocal microscopy, and the ocular surface status was evaluated by tear break-up times. RESULTS The mean age of 33 patients with blepharoptosis and 17 normal controls were 38.77 ± 22.81 years and 48.35 ± 17.15 years, respectively. The mean duration of blepharoptosis was 16.42 ± 15.60 years. In 13 patients with unilateral blepharoptosis, there was no significant difference between affected eyes and contralateral eyes (all ps > .05), except for wider corneal nerve fibre width (CNFW) in affected eyes (0.024 ± 0.001 versus 0.023 ± 0.001 mm/mm2, p = .021). In 20 patients with bilateral blepharoptosis, there was no significant difference between the eyes. No significant difference was detected between 19 cases with congenital blepharoptosis and 14 cases with aponeurogenic blepharoptosis. When compared with normal controls, eyes with both unilateral and bilateral blepharoptosis had significantly wider CNFW. But from the point of aetiology, only eyes with congenital blepharoptosis presented with wider CNFW (p = .001), rather than the eyes with aponeurogenic blepharoptosis (p = .093). Besides, four young patients with congenital blepharoptosis revealed very sparse sub-basal nerve plexus. CONCLUSIONS These data suggested that corneal confocal microscopy demonstrated no significant changes in patients with blepharoptosis as compared with normal controls, except for relatively wider CNFW in congenital affected eyes. However, in some children and young adults with congenital blepharoptosis, the density of corneal sub-basal nerve plexus was evidently decreased, which needs to be cautioned when ones with congenital blepharoptosis want to take corneal surgeries or wear contact lens.Key messagesWhen compared with normal controls, no significant effect was found in the influence of blepharoptosis on the most of corneal nerve parameters, except for corneal nerve fibre width (CNFW) in the group of congenital blepharoptosis.The age of onset of blepharoptosis may influence corneal nerve fibres, so timely surgical treatment of congenital blepharoptosis is not only conducive to the development of normal vision, but also beneficial to the reduction of corneal nerve lesions to some extent.We noted that some young blepharoptosis patients revealed sparse corneal nerve, which should be taken precaution when ones with congenital blepharoptosis who want to take corneal surgeries or wear contact lens.
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Affiliation(s)
- Zhengwei Zhang
- Department of Ophthalmology, Affiliated Wuxi Clinical College of Nantong University, Wuxi, People's Republic of China.,Department of Ophthalmology, The Affiliated Wuxi No. 2 People's Hospital of Nanjing Medical University, Wuxi, People's Republic of China
| | - Shui Lu
- Department of Ophthalmology, Affiliated Wuxi Clinical College of Nantong University, Wuxi, People's Republic of China.,Department of Ophthalmology, The Affiliated Wuxi No. 2 People's Hospital of Nanjing Medical University, Wuxi, People's Republic of China
| | - Yunjia Jiang
- Department of Ophthalmology, Affiliated Wuxi Clinical College of Nantong University, Wuxi, People's Republic of China.,Department of Ophthalmology, The Affiliated Wuxi No. 2 People's Hospital of Nanjing Medical University, Wuxi, People's Republic of China
| | - Song Sun
- Department of Ophthalmology, Affiliated Wuxi Clinical College of Nantong University, Wuxi, People's Republic of China.,Department of Ophthalmology, The Affiliated Wuxi No. 2 People's Hospital of Nanjing Medical University, Wuxi, People's Republic of China
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Piona C, Costantini S, Zusi C, Cozzini T, Pedrotti E, Marigliano M, Fornari E, Maguolo A, Morandi A, Maffeis C. Early marker of ocular neurodegeneration in children and adolescents with type 1 diabetes: the contributing role of polymorphisms in mir146a and mir128a genes. Acta Diabetol 2022; 59:1551-1561. [PMID: 36002591 PMCID: PMC9581843 DOI: 10.1007/s00592-022-01919-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 06/07/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Early ocular neurodegenerative signs of diabetic neuropathy (DN) can be found in children and adolescents with type 1 diabetes (T1D). No data are available on the potential role of polymorphisms in miRNAs genes in predisposing T1D subjects to these signs. AIMS To determine whether MIR146A rs2910164 and MIR128A rs11888095 polymorphisms are associated with early retinal and corneal neurodegenerative changes in pediatric patients with T1D. METHODS A total of 140 T1D children/adolescents underwent spectral domain-optical coherence tomography (SD-OCT) and in vivo confocal microscopy (IVCM) with measurement of retinal and corneal nerve fiber parameters. Risk factors for diabetes complications (diabetes duration, blood pressure, HbA1c) were recorded. Genotyping of rs2910164 and rs1188095 SNPs and genotype-phenotype association analysis were performed. RESULTS The C allele of rs2910164 in MIR146A was associated with higher values of IVCM parameters and minimum rim width (MRW) of the peripapillary region of optic nerve head measured in the retina, whereas the T allele of rs1188095 in MIR128A was associated with a significant impairment of them. Multiple regression analysis showed that MIR146A and MIR128A polymorphisms were significantly associated with corneal nerve fiber length (beta = 0.225 and - 0.204, respectively) and other IVCM parameters, independently from age, diabetes duration, HbA1c and systolic blood pressure percentile. Similar results were found for MRW (beta = 0.213 and - 0.286, respectively). CONCLUSIONS These results provide new insight into the genetic predisposition to DN showing that two polymorphisms in MIR146A and MIR128A genes could significantly contribute to the development of early ocular preclinical signs of DN.
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Affiliation(s)
- Claudia Piona
- Section of Pediatric Diabetes and Metabolism, Department of Surgery, Dentistry, Pediatrics, and Gynecology, University of Verona, Verona, P.le Stefani 1, 37126, Verona, Italy
| | - Silvia Costantini
- Section of Pediatric Diabetes and Metabolism, Department of Surgery, Dentistry, Pediatrics, and Gynecology, University of Verona, Verona, P.le Stefani 1, 37126, Verona, Italy
| | - Chiara Zusi
- Section of Pediatric Diabetes and Metabolism, Department of Surgery, Dentistry, Pediatrics, and Gynecology, University of Verona, Verona, P.le Stefani 1, 37126, Verona, Italy
| | - Tiziano Cozzini
- Department of Neuroscience, Biomedicine and Movement Sciences, Eye Clinic, University of Verona, P.le L. A. Scuro 10, 37134, Verona, Italy
| | - Emilio Pedrotti
- Department of Neuroscience, Biomedicine and Movement Sciences, Eye Clinic, University of Verona, P.le L. A. Scuro 10, 37134, Verona, Italy
| | - Marco Marigliano
- Section of Pediatric Diabetes and Metabolism, Department of Surgery, Dentistry, Pediatrics, and Gynecology, University of Verona, Verona, P.le Stefani 1, 37126, Verona, Italy
| | - Elena Fornari
- Section of Pediatric Diabetes and Metabolism, Department of Surgery, Dentistry, Pediatrics, and Gynecology, University of Verona, Verona, P.le Stefani 1, 37126, Verona, Italy
| | - Alice Maguolo
- Section of Pediatric Diabetes and Metabolism, Department of Surgery, Dentistry, Pediatrics, and Gynecology, University of Verona, Verona, P.le Stefani 1, 37126, Verona, Italy
| | - Anita Morandi
- Section of Pediatric Diabetes and Metabolism, Department of Surgery, Dentistry, Pediatrics, and Gynecology, University of Verona, Verona, P.le Stefani 1, 37126, Verona, Italy.
| | - Claudio Maffeis
- Section of Pediatric Diabetes and Metabolism, Department of Surgery, Dentistry, Pediatrics, and Gynecology, University of Verona, Verona, P.le Stefani 1, 37126, Verona, Italy
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7
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Cosmo E, Midena G, Frizziero L, Bruno M, Cecere M, Midena E. Corneal Confocal Microscopy as a Quantitative Imaging Biomarker of Diabetic Peripheral Neuropathy: A Review. J Clin Med 2022; 11:jcm11175130. [PMID: 36079060 PMCID: PMC9457345 DOI: 10.3390/jcm11175130] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/26/2022] [Accepted: 08/29/2022] [Indexed: 11/16/2022] Open
Abstract
Distal symmetric polyneuropathy (DPN), particularly chronic sensorimotor DPN, represents one of the most frequent complications of diabetes, affecting 50% of diabetic patients and causing an enormous financial burden. Whilst diagnostic methods exist to detect and monitor this condition, they have significant limitations, mainly due to their high subjectivity, invasiveness, and non-repeatability. Corneal confocal microscopy (CCM) is an in vivo, non-invasive, and reproducible diagnostic technique for the study of all corneal layers including the sub-basal nerve plexus, which represents part of the peripheral nervous system. We reviewed the current literature on the use of CCM as an instrument in the assessment of diabetic patients, particularly focusing on its role in the study of sub-basal nerve plexus alterations as a marker of DPN. CCM has been demonstrated to be a valid in vivo tool to detect early sub-basal nerve plexus damage in adult and pediatric diabetic patients, correlating with the severity of DPN. Despite its great potential, CCM has still limited application in daily clinical practice, and more efforts still need to be made to allow the dissemination of this technique among doctors taking care of diabetic patients.
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Affiliation(s)
| | | | - Luisa Frizziero
- Department of Neuroscience-Ophthalmology, University of Padova, 35128 Padova, Italy
| | | | | | - Edoardo Midena
- IRCCS—Fondazione Bietti, 00198 Rome, Italy
- Department of Neuroscience-Ophthalmology, University of Padova, 35128 Padova, Italy
- Correspondence: ; Tel.: +39-049-821-2110
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8
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In Vivo Confocal Microscopy in Different Types of Dry Eye and Meibomian Gland Dysfunction. J Clin Med 2022; 11:jcm11092349. [PMID: 35566475 PMCID: PMC9099706 DOI: 10.3390/jcm11092349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 04/07/2022] [Accepted: 04/20/2022] [Indexed: 02/05/2023] Open
Abstract
In vivo confocal microscopy (IVCM) imaging is increasingly popular in ocular surface disease diagnosis and management. We conducted a systematic review to update the use of IVCM in the diagnosis and treatment of dry eye and meibomian gland dysfunction (MGD). A literature review was conducted on IVCM studies in MGD, dry eye disease, systemic disease causing dry eye, dry eye in glaucoma patients, contact lens-associated ocular conditions, graft-versus-host disease, and Sjogren’s syndrome-related dry eye. The articles were identified through PubMed and a total number of 63 eligible publications were analyzed in detail. All primary research studies on confocal microscopy on dry eye and related conditions from 2017 onwards were included. The reports were reviewed for their contribution to the existing literature as well as potential biases and drawbacks. Despite limitations such as small field of view, lack of population-based norms, and lack of standardization of image acquisition, interpretation, and quantification, IVCM is useful as a complementary technique for clinical diagnosis in various ocular surface disorders related to dry eye. With advances in hardware and software in the near future, it has the potential for further practical impact.
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9
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Gu Y, Liu X, Yu X, Qin Q, Yu N, Ke W, Wang K, Chen M. Corneal in vivo Confocal Microscopy for Assessment of Non-Neurological Autoimmune Diseases: A Meta-Analysis. Front Med (Lausanne) 2022; 9:809164. [PMID: 35372389 PMCID: PMC8965464 DOI: 10.3389/fmed.2022.809164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 02/07/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose This study aimed to evaluate the features of corneal nerve with in vivo confocal microscopy (IVCM) among patients with non-neurological autoimmune (NNAI) diseases. Methods We systematically searched PubMed, Web of Science, and Cochrane Central Register of Controlled Trials for studies published until May 2021. The weighted mean differences (WMDs) of corneal nerve fiber length (CNFL), corneal nerve fiber density (CNFD), corneal nerve branch density (CNBD), tortuosity, reflectivity, and beadings per 100 μm with a 95% CI between NNAI and control group were analyzed using a random-effects model. Results The results showed 37 studies involving collective totals of 1,423 patients and 1,059 healthy controls were ultimately included in this meta-analysis. The pooled results manifested significantly decreased CNFL (WMD: −3.94, 95% CI: −4.77–−3.12), CNFD (WMD: −6.62, 95% CI: −8.4–−4.85), and CNBD (WMD: −9.89, 95% CI: −14–−5.79) in NNAI patients. In addition, the NNAI group showed more tortuous corneal nerve (WMD: 1.19, 95% CI:0.57–1.81). The comparison between NNAI patients and healthy controls in beadings per 100 μm corneal nerve length was inconsistent. No significant difference was found in the corneal nerve fiber reflectivity between NNAI and the control group (WMD: −0.21, 95% CI: −0.65–0.24, P = 0.361). Conclusions The parameters and morphology of corneal nerves observed by IVCM proved to be different in NNAI patients from healthy controls, suggesting that IVCM may be a non-invasive technique for identification and surveillance of NNAI diseases.
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Affiliation(s)
- Yuxiang Gu
- Eye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Zhejiang Provincial Key Lab of Ophthalmology, Hangzhou, China
| | - Xin Liu
- Eye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Zhejiang Provincial Key Lab of Ophthalmology, Hangzhou, China
| | - Xiaoning Yu
- Eye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Zhejiang Provincial Key Lab of Ophthalmology, Hangzhou, China
| | - Qiyu Qin
- Eye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Zhejiang Provincial Key Lab of Ophthalmology, Hangzhou, China
| | - Naiji Yu
- Eye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Zhejiang Provincial Key Lab of Ophthalmology, Hangzhou, China
| | - Weishaer Ke
- Eye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Zhejiang Provincial Key Lab of Ophthalmology, Hangzhou, China
| | - Kaijun Wang
- Eye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Zhejiang Provincial Key Lab of Ophthalmology, Hangzhou, China
| | - Min Chen
- Eye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Zhejiang Provincial Key Lab of Ophthalmology, Hangzhou, China
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10
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Rasmussen VF, Thrysøe M, Tankisi H, Karlsson P, Vestergaard ET, Kristensen K, Nyengaard JR, Krogh K, Brock C, Terkelsen AJ. Treatment‐induced neuropathy of diabetes in an adolescent with rapid reduction in HbA1c and weight loss: Persistent neuropathic findings at follow‐up after 1.5 years. Clin Case Rep 2022; 10:e05415. [PMID: 35169470 PMCID: PMC8831948 DOI: 10.1002/ccr3.5415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/08/2022] [Accepted: 01/24/2022] [Indexed: 11/10/2022] Open
Abstract
Treatment‐induced neuropathy of diabetes (TIND) is a condition occurring within weeks after a rapid decline in blood glucose. This case report illustrates consequences in an adolescent with TIND. Gold standard methods diagnosing large fiber, small fiber, and autonomic neuropathy were abnormal at 1.5 years of follow‐up. Awareness of TIND is important.
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Affiliation(s)
- Vinni Faber Rasmussen
- Danish Pain Research Center Department of Clinical Medicine Aarhus University Aarhus Denmark
- Department of Pediatrics and Adolescents Randers Regional Hospital Randers Denmark
| | - Mathilde Thrysøe
- Danish Pain Research Center Department of Clinical Medicine Aarhus University Aarhus Denmark
| | - Hatice Tankisi
- Department of Neurophysiology Department of Clinical Medicine Aarhus University Aarhus Denmark
| | - Páll Karlsson
- Danish Pain Research Center Department of Clinical Medicine Aarhus University Aarhus Denmark
- Core Centre for Molecular Morphology Section for Stereology and Microscopy Department of Clinical Medicine Aarhus University Aarhus Denmark
| | - Esben Thyssen Vestergaard
- Department of Pediatrics and Adolescents Randers Regional Hospital Randers Denmark
- Steno Diabetes Center Aarhus Aarhus University Hospital Aarhus Denmark
| | - Kurt Kristensen
- Steno Diabetes Center Aarhus Aarhus University Hospital Aarhus Denmark
| | - Jens Randel Nyengaard
- Core Centre for Molecular Morphology Section for Stereology and Microscopy Department of Clinical Medicine Aarhus University Aarhus Denmark
- Department of Pathology Aarhus University Hospital Aarhus Denmark
| | - Klaus Krogh
- Steno Diabetes Center Aarhus Aarhus University Hospital Aarhus Denmark
- Department of Hepatology and Gastroenterology Aarhus University Hospital Aarhus Denmark
| | - Christina Brock
- Department of Gastroenterology Aalborg University Hospital Aalborg Denmark
| | - Astrid Juhl Terkelsen
- Danish Pain Research Center Department of Clinical Medicine Aarhus University Aarhus Denmark
- Department of Neurology Aarhus University Hospital Aarhus Denmark
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Piona C, Ventrici C, Marcovecchio L, Chiarelli F, Maffeis C, Bonfanti R, Rabbone I. Long-term complications of type 1 diabetes: what do we know and what do we need to understand? Minerva Pediatr (Torino) 2021; 73:504-522. [PMID: 34530587 DOI: 10.23736/s2724-5276.21.06545-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Long-term complications of type 1 diabetes (T1D) include microvascular complications and macrovascular disease. Despite the important advances in the treatment of T1D of the last decades, these complications still represent the leading cause of morbidity and mortality in patients with T1D. Extensive evidence indicates that structural and functional alterations of the kidney, retina, nerves and large arteries occur already in the first years after the onset of diabetes. We performed a comprehensive review of the available evidence on screening, diagnosis, prevention and treatment of vascular complications of T1D. In particular, we focused on three major challenges related to long-term complications of T1D: 1) finding of new biomarkers and diagnostic methods able to identify early signs of complications; 2) identifying specific risk factors for the development of these complications; 3) identifying and implementing new therapeutic strategies able to prevent the development and progression of vascular complications.
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Affiliation(s)
- Claudia Piona
- Paediatric Diabetes and Metabolic Disorders Unit, Regional Center for Paediatric Diabetes, University City Hospital of Verona, Italy
| | - Claudia Ventrici
- Paediatric Unit, Hospital of Polistena, Polistena, Reggio Calabria, Italy
| | | | | | - Claudio Maffeis
- Paediatric Diabetes and Metabolic Disorders Unit, Regional Center for Paediatric Diabetes, University City Hospital of Verona, Italy
| | - Riccardo Bonfanti
- Diabetes Research Institute, Department of Pediatrics, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Ivana Rabbone
- Division of Paediatrics, Department of Health Sciences, University of Piemonte Orientale, Novara, Italy -
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12
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Cozzini T, Piona C, Marchini G, Merz T, Brighenti T, Bonetto J, Marigliano M, Olivieri F, Maffeis C, Pedrotti E. In vivo confocal microscopy study of corneal nerve alterations in children and youths with Type 1 diabetes. Pediatr Diabetes 2021; 22:780-786. [PMID: 33934464 PMCID: PMC8360056 DOI: 10.1111/pedi.13219] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 03/13/2021] [Accepted: 04/16/2021] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE To determine whether children and youths with Type 1 diabetes (T1D) have early alterations of the corneal subbasal nerve plexus detectable with in vivo confocal microscopy (IVCM) and to investigate the role of longitudinally measured major risk factors for diabetes complications associated with these alterations. METHODS One hundred and fifty children and youths with T1D and 51 age-matched controls were enrolled and underwent IVCM. Corneal nerve fiber length (CNFL), corneal nerve fiber density (CNFD), corneal nerve branch density (CNBD), corneal fiber total branch density (CTBD), and corneal fiber fractal dimension (CNFrD) were measured. Risk factors for diabetes complications (blood pressure, BMI, HbA1c, lipoproteins, urinary albumin-creatinine ratio) were recorded at IVCM and longitudinally since T1D onset. Unpaired t-test was used to compare variables between the groups. Multiple regression models were calculated using IVCM parameters as dependent variables and risk factors as independent variables. RESULTS All IVCM parameters, except CTBD, were significantly lower in the T1D patients. Glycometabolic control (HbA1c, visit-to-visit HbA1c variability, and mean HbA1c), and blood pressure were inversely correlated with IVCM parameters. Multiple regression showed that part of the variability in CNFL, CNFD, CTBD, and CNFraD was explained by HbA1c, blood pressure percentiles and age at IVCM examination, independent of diabetes duration, BMI percentile and LDL cholesterol. Comparable results were obtained using the mean value of risk factors measured longitudinally since T1D onset. CONCLUSIONS Early signs of corneal nerve degeneration were found in children and youths with T1D. Glycometabolic control and blood pressure were the major risk factors for these alterations.
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Affiliation(s)
- Tiziano Cozzini
- Department of Neuroscience, Biomedicine and Movement SciencesEye Clinic, University of VeronaVeronaItaly
| | - Claudia Piona
- Pediatric Diabetes and Metabolic Disorders Unit, Regional Center for Pediatric DiabetesUniversity City Hospital of VeronaVeronaItaly
| | - Giorgio Marchini
- Department of Neuroscience, Biomedicine and Movement SciencesEye Clinic, University of VeronaVeronaItaly
| | - Tommaso Merz
- Department of Neuroscience, Biomedicine and Movement SciencesEye Clinic, University of VeronaVeronaItaly
| | - Tommaso Brighenti
- Department of Neuroscience, Biomedicine and Movement SciencesEye Clinic, University of VeronaVeronaItaly
| | - Jacopo Bonetto
- Department of Neuroscience, Biomedicine and Movement SciencesEye Clinic, University of VeronaVeronaItaly
| | - Marco Marigliano
- Pediatric Diabetes and Metabolic Disorders Unit, Regional Center for Pediatric DiabetesUniversity City Hospital of VeronaVeronaItaly
| | - Francesca Olivieri
- Pediatric Diabetes and Metabolic Disorders Unit, Regional Center for Pediatric DiabetesUniversity City Hospital of VeronaVeronaItaly
| | - Claudio Maffeis
- Pediatric Diabetes and Metabolic Disorders Unit, Regional Center for Pediatric DiabetesUniversity City Hospital of VeronaVeronaItaly
| | - Emilio Pedrotti
- Department of Neuroscience, Biomedicine and Movement SciencesEye Clinic, University of VeronaVeronaItaly
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