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Corneal structure and sensitivity in type 1 diabetes mellitus
M E Rosenberg1, T M Tervo, I J Immonen
1Department of Ophthalmology, University of Helsinki, Finland. maria.rosenberg@hus.fi
Investigative Ophthalmology & Visual Science
|September 1, 2000
Summary
Diabetic patients show early nerve fiber loss in the cornea, detectable by confocal microscopy, even before sensitivity decreases. Corneal thickness increases initially, but severe neuropathy thins the epithelium, risking erosions.
Area of Science:
- Ophthalmology
- Diabetology
- Neurology
Background:
- Diabetic corneal complications, including impaired wound healing, are significant clinical concerns.
- Subbasal nerve morphology and corneal sensitivity are affected in diabetic patients.
Purpose of the Study:
- To investigate corneal changes in type 1 diabetes mellitus patients.
- To correlate corneal sensitivity, subbasal nerve morphology, and polyneuropathy severity.
Main Methods:
- In vivo confocal microscopy assessed corneal morphology, epithelial/corneal thickness, and subbasal nerve density.
- Corneal sensitivity was measured using a Cochet-Bonnet esthesiometer.
- Polyneuropathy and retinopathy were evaluated using the Michigan Neuropathy Screening Instrument and fundus photography, respectively.
Main Results:
- Reduced subbasal nerve fiber bundles were observed in mild to moderate neuropathy.
- Corneal sensitivity decreased only in severe neuropathy.
- Corneal thickness increased in diabetic patients without neuropathy; epithelium thinned in those with severe neuropathy.
Conclusions:
- Confocal microscopy enables early neuropathy detection by identifying decreased nerve fiber bundles preceding sensitivity loss.
- Corneal thickness increases early in diabetes but stabilizes; severe neuropathy may lead to epithelial thinning and recurrent erosions due to reduced neurotrophic support.