Abstract WP94: Association of Corneal and Retinal Nerves With Cerebral Small Vessel Disease in Patients With Acute Ischemic Stroke

Abstract

Introduction: Cerebral small vessel disease (SVD) confers an increased risk of stroke, dementia and death. Corneal confocal microscopy (CCM) and Optical Coherence Tomography (OCT) are ophthalmic instruments which can detect neuronal loss non-invasively and may be useful surrogate markers for white matter disease (WMD). Hypothesis: To determine whether corneal and retinal nerve pathology identified using CCM and OCT, respectively, are associated with cerebral SVD in patients with acute ischemic stroke. Methods: 248 patients admitted with acute ischemic stroke underwent CCM to quantify corneal nerve fiber density (CNFD), corneal nerve fiber length (CNFL), corneal nerve branch density (CNBD) and OCT to quantify central foveal ganglion cell complex (CF-GCC). SVD was graded in periventricular (PV) and deep white matter (DWM) regions according to the Fazekas scale and white matter hyperintensities (WMH) were quantified. Statistical analysis was performed using ANOVA and multiple regression. Results: DWMSVD and PVSVD were absent (50%,40%) or present with mild (37%,37%), moderate (9%,16%) and severe (4%,7%) severity in patients with acute ischemic stroke. CNFD was significantly lower in patients with mild PVSVD (P=0.02) and severe PVSVD (P=0.004) and DWMSVD (P=0.026) compared to no SVD. CNBD was significantly lower in patients with severe PVSVD (P=0.020) compared to no PVSVD. CF-GCC was significantly lower in patients with moderate PVSVD (P=0.012) and DWMSVD (P=0.044) and severe PVSVD (P=0.012) compared to no SVD. Comparing patients with and without WMH, CF-GCC was significantly lower (P=0.045), but there was no difference for CCM. Multiple regression analysis showed an association between CNFD and PVSVD severity (β= –1.416, P=0.014) and triglyerides (β=1.146, P=0.016). There was no correlation between DWSVD and PVSVD with age, cholestrol, HbA 1c or blood pressure. Conclusions: Corneal confocal microscopy and optical coherence tomography allow rapid non-invasive identification of corneal and retinal nerve pathology in patients with moderate and severe SVD. Furthermore, corneal nerve fibre density correlates with the severity of PVSVD and triglycerides.