Misra Stuti L, Slater James A, Makam Rahul, Braatvedt Geoffrey D, Beban Grant, Pradhan Monika, Mankowski Joseph L, Oakley Jonathan D, McGhee Charles N J
Department of Ophthalmology, Faculty of Medical and Health Sciences, New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand.
Department of Ophthalmology, Faculty of Medical and Health Sciences, New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand.
Ocul Surf. 2024 Oct;34:140-145. doi: 10.1016/j.jtos.2024.07.006. Epub 2024 Jul 23.
Diabetic peripheral neuropathy can be detected using non-invasive in vivo confocal microscopy of the cornea (IVCM) and such abnormalities may precede the development of clinical neuropathy. The current study aimed to assess any progression or remission of corneal and peripheral neuropathy in patients with type 2 diabetes undergoing bariatric surgery.
People with known type 2 diabetes for at least five years and listed for bariatric surgery were recruited. Participants were assessed before, and 12, 26, and 52 weeks following bariatric surgery. IVCM and corneal sensitivity measurements were performed. A modified total neuropathy score (mTNS) was obtained from neuropathy questionnaire, clinical assessment and biothesiometry.
Twenty-nine participants (M:F, 11:18) with mean BMI of 44.7 ± 6.4 kg/m, and 11 ± 7.6 years duration of diabetes, were assessed. Corneal sub-basal nerve fibre length (CNFL), displayed an increase from a baseline mean of 12.20 ± 1.00 to 17.48 ± 0.92 mm/mm at 52 weeks (p < 0.0001). Corneal sensitivity threshold displayed a decrease over time, thus corneal sensitivity improved, falling from a mean of 1.11 ±0 .15 to 0.62 ± 0.11 (mBAR) (p < 0.0001). Clinical neuropathy scores demonstrated significant improvements from baseline, displaying a decrease in average mTNS score from 3.29 ± 0.68 to 0.76 ± 0.30 (p < 0.0001). A significant inverse relationship was shown between CNFL and sensitivity (β coefficient = -0.047, p < 0.001), and CNFL and mTNS (β coefficient = -0.178, p < 0.001).
Bariatric surgery led to an improvement in metabolic control of diabetes and weight loss, along with improvement in corneal nerve microstructure, corneal sensitivity, and neuropathic symptoms, suggesting a reversal of both small and large fibre neuropathy.
可通过角膜体内共聚焦显微镜检查（IVCM）检测糖尿病周围神经病变，且此类异常可能先于临床神经病变的发生。本研究旨在评估接受减肥手术的2型糖尿病患者角膜和周围神经病变的任何进展或缓解情况。
招募已知患有2型糖尿病至少五年且已列入减肥手术名单的患者。在减肥手术前、术后12周、26周和52周对参与者进行评估。进行IVCM和角膜敏感性测量。通过神经病变问卷、临床评估和生物感觉测量获得改良的总神经病变评分（mTNS）。
评估了29名参与者（男:女，11:18），平均体重指数为44.7±6.4kg/m²，糖尿病病程为11±7.6年。角膜基底膜下神经纤维长度（CNFL）从基线平均值12.20±1.00增加到52周时的17.48±0.92mm/mm（p<0.0001）。角膜敏感性阈值随时间降低，因此角膜敏感性得到改善，从平均值1.11±0.15降至0.62±0.11（mBAR）（p<0.0001）。临床神经病变评分显示与基线相比有显著改善，平均mTNS评分从3.29±0.68降至0.76±0.30（p<0.0001）。CNFL与敏感性之间显示出显著的负相关（β系数=-0.047，p<0.001），CNFL与mTNS之间也显示出显著的负相关（β系数=-0.178，p<0.001）。
减肥手术导致糖尿病代谢控制改善和体重减轻，同时角膜神经微结构、角膜敏感性和神经病变症状也得到改善，提示小纤维和大纤维神经病变均有逆转。
