Early diagnosis of diabetic polyneuropathy based on the results of corneal nerve fibers examination

S.E. Avetisov

Krasnov Research Institute of Eye Disease;
I.M. Sechenov First Moscow State Medical University (Sechenov University)

ORCID: 0000-0001-7115-4275

N.A. Chernenkova

Research Institute of Eye Diseases;
Research Center of Neurology

Z.V. Surnina

Krasnov Research Institute of Eye Diseases

ORCID: 0000-0001-5692-1800

L.T. Akhmedzhanova

I.M. Sechenov First Moscow State Medical University (Sechenov University)

A.S. Fokina

I.M. Sechenov First Moscow State Medical University (Sechenov University)

I.A. Strokov

Sechenov First Moscow State Medical University (Sechenov University)

ORCID: 0000-0001-6950-7166

Early diagnosis of diabetic polyneuropathy based on the results of corneal nerve fibers examination

Authors:

S.E. Avetisov, N.A. Chernenkova, Z.V. Surnina, L.T. Akhmedzhanova, A.S. Fokina, I.A. Strokov

More about the authors

Journal: Russian Annals of Ophthalmology. 2020;136(5): 155‑162

DOI: 10.17116/oftalma2020136052155

Downloaded: 29

To cite this article:

Avetisov SE, Chernenkova NA, Surnina ZV, Akhmedzhanova LT, Fokina AS, Strokov IA. Early diagnosis of diabetic polyneuropathy based on the results of corneal nerve fibers examination. Russian Annals of Ophthalmology. 2020;136(5):155‑162. (In Russ., In Engl.)
https://doi.org/10.17116/oftalma2020136052155

Доказательная гастроэнтерология: pro et contra

Актуальные вопросы педиатрической практики

Использование инфографики авторами научных работ

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PURPOSE

To conduct comparative analysis of the results of CNF assessment using CCM and other known neurological instrumental techniques as well as evaluate their applicability to the early diagnosis of diabetic polyneuropathy (DPN).

MATERIAL AND METHODS

We examined a total of 46 patients (85 eyes) with type 1 DM and either subclinical (24 patients), or clinical-stage DPN (22 patients) and 50 patients (87 eyes) with type 2 DM (subclinical DPN in 27 patients and clinical-stage DPN in 23 patients). The control group consisted of 34 healthy volunteers (68 eyes). All patients underwent standard ophthalmological examination, CCM with nerve tortuosity assessment (including calculation of coefficients of CNF orientation anisotropy, K_ΔL, and symmetry, K_sym) and interocular asymmetry, electroneuromyography (ENMG), and quantitative sensory testing (QST).

RESULTS

Analysis of the CCM results revealed a reliable decrease in the average K_ΔL values in patients with type 1 and type 2 DM compared with the control group. In the group of patients with type 1 DM and subclinical DPN, correlations were revealed between the CNF tortuosity coefficients and a number of ENMG parameters, such as the M-response amplitude of the peroneal nerve (r=0.73, p≤0.02), M-response amplitude of the tibial nerve (r=0.58, p≤0.01), residual latency (r= –0.62, p≤0.05), and peroneal nerve conduction velocity (r=0.57, p≤0.01). K_sym values correlated with the warm sensitivity threshold (r=0.6, p≤0.008). Among patients with type 2 DM and subclinical DPN, the K_ΔL coefficient correlated with the peroneal nerve conduction velocity (r=0.46, p≤0.02), M-response amplitude of the tibial nerve (r=0.6, p≤0.04), and residual latency of the peroneal nerve (r=–0.56, p≤0.05).

CONCLUSION

The state of thin corneal nerves correlates with functional changes in the peripheral nerves. Pathological changes in CNF in patients with DM can be detected at an early (subclinical) stage of DPN using laser CCM and a program for corneal nerve tortuosity analysis.

Keywords:

laser confocal microscopy

coefficients of corneal nerve fibers orientation anisotropy and symmetry

electroneuromyography

quantitative sensory testing

diabetic polyneuropathy

Authors:

S.E. Avetisov

Krasnov Research Institute of Eye Disease;
I.M. Sechenov First Moscow State Medical University (Sechenov University)

ORCID: 0000-0001-7115-4275

N.A. Chernenkova

Research Institute of Eye Diseases;
Research Center of Neurology

Z.V. Surnina

Krasnov Research Institute of Eye Diseases

ORCID: 0000-0001-5692-1800

L.T. Akhmedzhanova

I.M. Sechenov First Moscow State Medical University (Sechenov University)

A.S. Fokina

I.M. Sechenov First Moscow State Medical University (Sechenov University)

I.A. Strokov

Sechenov First Moscow State Medical University (Sechenov University)

ORCID: 0000-0001-6950-7166

Received:

04.02.2020

Accepted:

25.03.2020

List of references:

Eichholz M, Alexander AH, Cappelleri JC, Hlavacek P, Parsons B, Sadosky A, Tuchman MM. Perspectives on the impact of painful diabetic peripheral neuropathy in a multicultural population. Clin Diabetes Endocrinol. 2017;3:12. https://doi.org/10.1186/s40842-017-0051-2
Hsu WC, Chiu SY, Yen AM, et al. Somatic neuropathy is an independent predictor of all- and diabetes-related mortality in type 2 diabetic patients: a population-based 5-year follow-up study. Eur J Neurol. 2012;19(9):1192-1198. https://doi.org/10.1111/j.1468-1331.2011.03659.x
Abbott CA, Malik RA, van Ross ER, Kulkarni J, Boulton AJ. Prevalence and characteristics of painful diabetic neuropathy in a large community-based diabetic population in the U.K. Diabetes Care. 2011;34:2220-2224. https://doi.org/10.2337/dc11-1108
Thomas PK. Classification, differential diagnosis, and staging of diabetic peripheral neuropathy. Diabetes. 1997;46(2):54-57. https://doi.org/10.2337/diab.46.2.s54
Smith AG, Ramachandran P, Tripp S, Singleton JR. Epidermal nerve innervation in impaired glucose tolerance and diabetes-associated neuropathy. Neurology. 2001;57(9):1701-1704. https://doi.org/10.1212/wnl.57.9.1701
Sumner CJ, Sheth S, Griffin JW, Cornblath DR, Polydefkis M. The spectrum of neuropathy in diabetes and impaired glucose tolerance. Neurology. 2003;60(1):108-111. https://doi.org/10.1212/wnl.60.1.108
Breiner A, Lovblom LE, Perkins BA, et al. Does the prevailing hypothesis that small-fiber dysfunction precedes large-fiber dysfunction apply to type 1 diabetic patients? Diabetes Care. 2014;37(5):1418-1424. https://doi.org/10.2337/dc13-2005
Malik RA, Tesfaye S, Newrick PG, et al. Sural nerve pathology in diabetic patients with minimal but progressive neuropathy. Diabetologia. 2005;48(3): 578-585. https://doi.org/10.1007/s00125-004-1663-5
Smith AG, Russell J, Feldman EL, et al. Lifestyle Intervention for Pre-Diabetic Neuropathy. Diabetes Care. 2006;29(6):1294-1299. https://doi.org/10.2337/dc06-0224
Mehra S, Tavakoli M, Kallinikos PA, et al. Corneal Confocal Microscopy Detects Early Nerve Regeneration After Pancreas Transplantation in Patients With Type 1 Diabetes. Diabetes Care. 2007;30(10):2608-2612. https://doi.org/10.2337/dc07-0870
Sivaskandarajah GA, Halpern EM, Lovblom LE, Weisman A, Orlov S, Bril V, Perkins BA. Structure-function relationship between corneal nerves and conventional small-fiber tests in type 1 diabetes. Diabetes Care. 2013;36(9):2748-2755. https://doi.org/10.2337/dc12-2075
Ziegler D, Papanas N, Zhivov A, et al. Early detection of nerve fiber loss by corneal confocal microscopy and skin biopsy in recently diagnosed type 2 diabetes. Diabetes. 2014;63(7):2454-2463. https://doi.org/10.2337/db13-1819
Li Q, Zhong Y, Zhang T, Zhang R, Zhang Q, Zheng H, Xiong Q. Quantitative analysis of corneal nerve fibers in type 2 diabetics with and without diabetic peripheral neuropathy: comparison of manual and automated assessments. Diabetes Research and Clinical Practice. 2019;151:33-36. https://doi.org/10.1016/j.diabres.2019.03.039
Avetisov SE, Novikov IA, Makhotin SS, Surnina ZV. New approach to corneal nerve fibers morphometry in diabetes mellitus on the basis of confocal biomicroscopy. Vestnik oftal’mologii. 2015;131(4):5-11. (In Russ.). https://doi.org/10.17116/oftalma201513145-11
Avetisov SE, Novikov IA, Makhotin SS, Surnina ZV. Calculation of Anisotropy and Symmetry Coefficients of Corneal Nerve Orientation Based on Automated Recognition of Digital Confocal Images. Meditsinskaya tekhnika. 2015;49(3):23-25. (In Russ.). https://doi.org/10.1007/s10527-015-9519-5
Avdeev RV, Aleksandrov AS, Arapiev MU. Suspected glaucoma and early stage glaucoma: differential diagnostic criteria. Rossiiskii oftal’mologicheskii zhurnal = Russian Ophthalmological Journal. 2017;10(4):5-15. (In Russ.). https://doi.org/10.21516/2072-0076-2017-10-4-5-15
Strakhov VV, Ermakova AV, Popova AA, Korchagin NV. The research of interocular asymmetry is an important tool in the diagnosis and monitoring of primary glaucoma. RMZh. Klinicheskaya oftal’mologiya. 2014;2:93-95. (In Russ.).
Blackburn A. Bilateral asymmetry of the humerus during growth and development. American Journal of Physical Anthropology. 2011;145(4):639-646. https://doi.org/10.1002/ajpa.21555
Forensic and Anthropological Application of Body Asymmetry: A Comment on Gutnik, et al. (2015). Perceptual and Motor Skills. 2016;122(2):578-582. https://doi.org/10.1177/0031512516640667
Ahmed A, Bril V, Orszag A, Paulson J, Yeung E, Ngo M, Orlov S, Perkins BA. Detection of Diabetic Sensorimotor Polyneuropathy by Corneal Confocal Microscopy in Type 1 Diabetes: A concurrent validity study. Diabetes Care. 2012;35(4):821-828. https://doi.org/10.2337/dc11-1396
Ziegler D, Papanas N, Zhivov A, et al. Early detection of nerve fiber loss by corneal confocal microscopy and skin biopsy in recently diagnosed type 2 diabetes. Diabetes. 2014;63(7):2454-2463. https://doi.org/10.2337/db13-1819
Lauria G, Bakkers M, Schmitz C, et al. Intraepidermal nerve fiber density at the distal leg: a worldwide normative reference study. J Peripher Nerv Syst. 2010;15(3):202-207. https://doi.org/10.1111/j.1529-8027.2010.00271.x
Quattrini C, Tavakoli M, Kallinikos P, et al. Comparing skin biopsy with corneal confocal microscopy: diagnostic yield of nerve fiber density. Diabetologia. 2019;53(1):1-556 (2010). https://doi.org/10.1007/s00125-010-1872-z
Pritchard N, Edwards K, Russell AW, Perkins BA, Malik RA, Efron N. Corneal Confocal Microscopy Predicts 4-Year Incident Peripheral Neuropathy in Type 1 Diabetes. Diabetes Care. 2015;38(4):671-675. https://doi.org/10.2337/dc14-2114

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