Corneal confocal microscopy identifies greater corneal nerve damage in patients with a recurrent compared to first ischemic stroke

Adnan Khan,Ashfaq Shuaib,Naveed Akhtar,Georgios Ponirakis,Rumissa G Ibrahim,Blessy Babu,Saadat Kamran,Maher Saqqur,Namitha R Jose,Hoda Gad,Ioannis N Petropoulos,Rayaz A Malik,Hamad Almuhannadi,Paula Bourke,Masaki Mogi

doi:10.1371/journal.pone.0231987

Adnan Khan, Ashfaq Shuaib + Show 13 more

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https://doi.org/10.1371/journal.pone.0231987

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Abstract

Corneal nerve damage may be a surrogate marker for the risk of ischemic stroke. This study was undertaken to determine if there is greater corneal nerve damage in patients with recurrent ischemic stroke. Corneal confocal microscopy (CCM) was used to quantify corneal nerve fiber density (CNFD), corneal nerve branch density (CNBD), corneal nerve fiber length (CNFL) and corneal nerve fiber tortuosity (CNFT) in 31 patients with recurrent ischemic stroke, 165 patients with a first acute ischemic stroke and 23 healthy control subjects. Triglycerides (P = 0.004, P = 0.017), systolic BP (P = 0.000, P = 0.000), diastolic BP (P = 0.000, P = 0.000) and HbA1c (P = 0.000, P = 0.000) were significantly higher in patients with first and recurrent stroke compared to controls. There was no difference in age, BMI, HbA1c, total cholesterol, triglycerides, LDL, HDL, systolic and diastolic BP between patients with a first and recurrent ischemic stroke. However, CNFD was significantly lower (24.98±7.31 vs 29.07±7.58 vs 37.91±7.13, P<0.05) and CNFT was significantly higher (0.085±0.042 vs 0.064±0.037 vs 0.039±0.022, P<0.05) in patients with recurrent stroke compared to first stroke and healthy controls. CNBD (42.21±24.65 vs 50.46±27.68 vs 87.24±45.85, P<0.001) and CNFL (15.66±5.70, P<0.001 vs 17.38±5.06, P = 0.003) were equally reduced in patients with first and recurrent stroke compared to controls (22.72±5.14). Corneal confocal microscopy identified greater corneal nerve fibre loss in patients with recurrent stroke compared to patients with first stroke, despite comparable risk factors. Longitudinal studies are required to determine the prognostic utility of corneal nerve fiber loss in identifying patients at risk of recurrent ischemic stroke.

Highlights

Recurrent stroke occurs in 11.1% of stroke patients within one year of the initial stroke [1], and is associated with greater disability and mortality [2]
corneal nerve fiber density (CNFD) was significantly lower (24.98±7.31 vs 29.07±7.58 vs 37.91±7.13, P
corneal nerve branch density (CNBD) (42.21±24.65 vs 50.46±27.68 vs 87.24±45.85, P

Summary

Introduction

Recurrent stroke occurs in 11.1% of stroke patients within one year of the initial stroke [1], and is associated with greater disability and mortality [2]. Age [4], dyslipidemia [5], smoking [6], diabetes, hypertension, homocysteine levels, atrial fibrillation [1], metabolic syndrome [7] and other risk factors [8,9,10] are associated with recurrent stroke. A recent study has shown that hypertension, prior symptomatic stroke and chronic infarcts on MRI were independently associated with recurrent stroke and this doubled the all-cause mortality [11]. The 5-year recurrent stroke risk in the presence of severe white matter changes is comparable to the presence of atrial fibrillation and hypertension [20]

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