De Clerck Eline E B, Schouten Jan S A G, Berendschot Tos T J M, Koolschijn Renée S, Nuijts Rudy M M A, Schram Miranda T, Schaper Nicolaas C, Henry Ronald M A, Dagnelie Pieter C, Ruggeri Alfredo, Guimarães Pedro, Stehouwer Coen D A, Webers Carroll A B
University Eye Clinic Maastricht, Maastricht University Medical Center +, Maastricht, the Netherlands.
Department of Internal Medicine, Maastricht University Medical Center +, Maastricht, the Netherlands.
Acta Ophthalmol. 2020 Aug;98(5):485-491. doi: 10.1111/aos.14359. Epub 2020 Feb 3.
In individuals with diabetes, injury to the corneal nerve fibres predisposes to delayed corneal epithelial healing, reduced corneal sensitivity and corneal erosion. We investigated to what extent a reduction in corneal nerve fibre length (CNFL) is present in individuals with prediabetes or type 2 diabetes (DM2) compared with individuals with normal glucose metabolism (NGM).
Using composite images acquired by corneal confocal microscopy, we assessed total CNFL per mm in the subbasal nerve plexus of the cornea in 134 participants (mean age 59 ± 8 years, 49% men, 87 NGM, 20 prediabetes, 27 DM2). Multivariable linear regression was used to assess the association between CNFL and glucose metabolism status, adjusted for age and sex.
In individuals with type 2 diabetes, the mean CNFL was significantly reduced [β = -1.86 mm/mm (95% CI -3.64 to -0.08), p = 0.04], as compared with individuals with normal glucose metabolism after adjustment for age and sex. Part of the reduction was present in individuals with prediabetes [β = -0.96 mm/mm (95% CI -2.91 to 0.99), p = 0.34], with a linear trend of corneal nerve fibre reduction with severity of glucose metabolism status (p trend = 0.04).
A significant reduction in CNFL was found in individuals with DM2 compared with individuals with NGM. A trend of reduction in CNFL was observed between individuals with NGM and prediabetes. The reduction in corneal nerve fibre length could contribute to a delayed corneal healing and an increased risk for corneal complications after surgery.
在糖尿病患者中，角膜神经纤维损伤易导致角膜上皮愈合延迟、角膜敏感性降低和角膜糜烂。我们研究了与葡萄糖代谢正常（NGM）的个体相比，糖尿病前期或2型糖尿病（DM2）个体的角膜神经纤维长度（CNFL）减少的程度。
我们使用角膜共聚焦显微镜获取的复合图像，评估了134名参与者（平均年龄59±8岁，49%为男性，87名NGM，20名糖尿病前期，27名DM2）角膜基底神经丛中每毫米的总CNFL。采用多变量线性回归评估CNFL与葡萄糖代谢状态之间的关联，并对年龄和性别进行了校正。
在2型糖尿病患者中，校正年龄和性别后，与葡萄糖代谢正常的个体相比，平均CNFL显著降低[β=-1.86mm/mm（95%CI -3.64至-0.08），p=0.04]。糖尿病前期个体也存在部分减少[β=-0.96mm/mm（95%CI -2.91至0.99），p=0.34]，角膜神经纤维减少与葡萄糖代谢状态严重程度呈线性趋势（p趋势=0.04）。
与NGM个体相比，DM2个体的CNFL显著降低。在NGM个体和糖尿病前期个体之间观察到CNFL减少的趋势。角膜神经纤维长度的减少可能导致角膜愈合延迟和手术后角膜并发症风险增加。
