Kallinikos Panagiotis, Berhanu Michael, O'Donnell Clare, Boulton Andrew J M, Efron Nathan, Malik Rayaz A
Eurolens Research, Department of Optometry and Neuroscience, University of Manchester Institute of Science and Technology, Manchester, United Kingdom.
Invest Ophthalmol Vis Sci. 2004 Feb;45(2):418-22. doi: 10.1167/iovs.03-0637.
Corneal confocal microscopy is a reiterative, rapid, noninvasive in vivo clinical examination technique capable of imaging corneal nerve fibers. Nerve fiber tortuosity may indicate a degenerative and attempted regenerative response of nerve fibers to diabetes. The purpose of this study was to define alterations in the tortuosity of corneal nerve fibers in relation to age, duration of diabetes, glycemic control, and neuropathic severity.
The cornea and collected images of the subbasal nerve plexus of 18 diabetic patients (stratified into mild, moderate, and severe neuropathic groups using conventional clinical measures of neuropathy) and 18 age-matched nondiabetic control subjects were scanned, and a novel mathematical paradigm was applied to quantify the extent of nerve tortuosity, which was termed the tortuosity coefficient (TC).
TC was significantly different between the four clinical groups (F(3) = 12.2, P < 0.001). It was significantly greater in the severe neuropathic group than in control subjects (P < 0.003) and in the mild (P < 0.004) and moderate (P < 0.01) neuropathic groups. TC did not correlate significantly with the age (r = -0.003, P > 0.05), duration of diabetes (r = -0.219, P > 0.05), or hemoglobin A1c (HbA1c; r = 0.155, P > 0.05) of diabetic patients.
Corneal confocal microscopy allows rapid, noninvasive in vivo evaluation of corneal nerve tortuosity. This morphologic abnormality relates to the severity of somatic neuropathy and may reflect an alteration in the degree of degeneration and regeneration in diabetes.
角膜共焦显微镜检查是一种可重复、快速、无创的体内临床检查技术，能够对角膜神经纤维进行成像。神经纤维迂曲可能表明神经纤维对糖尿病的退行性和再生尝试性反应。本研究的目的是确定角膜神经纤维迂曲度与年龄、糖尿病病程、血糖控制及神经病变严重程度之间的关系。
对18例糖尿病患者（使用传统神经病变临床指标分为轻度、中度和重度神经病变组）和18例年龄匹配的非糖尿病对照者的角膜及基底膜下神经丛进行扫描，并应用一种新的数学模型来量化神经迂曲程度，称为迂曲系数（TC）。
四个临床组之间的TC有显著差异（F(3)=12.2，P<0.001）。重度神经病变组的TC显著高于对照组（P<0.003）以及轻度（P<0.004）和中度（P<0.01）神经病变组。糖尿病患者的TC与年龄（r=-0.003，P>0.05）、糖尿病病程（r=-0.219，P>0.05）或糖化血红蛋白（HbA1c；r=0.155，P>0.05）均无显著相关性。
角膜共焦显微镜检查可对角膜神经迂曲进行快速、无创的体内评估。这种形态学异常与躯体神经病变的严重程度有关，可能反映了糖尿病中神经退变和再生程度的改变。
