Abstract
BackgroundThe alterations of subbasal nerve plexus (SBP) innervation and corneal sensation were estimated non-invasively and compared with the values in healthy volunteers. Additionally, this study addressed the relation of SBP changes to the retinal status, glycemic control and diabetes duration.Methodology/Principal FindingsEighteen eyes of diabetic patients with peripheral diabetic neuropathy aged 68.8±8.8 years and twenty eyes of healthy volunteers aged 66.3±13.3 yrs. were investigated with in vivo confocal laser-scanning microscopy (CLSM). An adapted algorithm for image analysis was used to quantify the morphological and topological properties of SBP. These properties were correlated to incidence of diabetic retinopathy (DR) and corneal sensation (Cochet-Bonnet esthesiometer). The developed algorithm allows a fully automated analysis of pre-segmented SBP structures. Altogether, 10 parameters were analysed, and all of them revealed significant differences between diabetic patients and healthy volunteers. The nerve fibre density, total fibre length and nerve branches were found to be significantly lower in patients with diabetes than those of control subjects (nerve fibre density 0.006±0.002 vs. 0.020±0.007 mm/mm2; total fibre length 6223±2419 vs. 19961±6553 µm; nerve branches 25.3±28.6 vs. 141.9±85.7 in healthy volunteers). Also the corneal sensation was significantly lower in diabetic group when compared to controls (43±11 vs. 59±18 mm). There was found no difference in SBP morphology or corneal sensation in the subgroups with (DR) or without (NDR) diabetic retinopathy.Conclusions/SignificanceSBP parameters were significantly reduced in diabetic patients, compared to control group. Interestingly, the SBP impairment could be shown even in the diabetic patients without DR. Although automatic adapted image analysis simplifies the evaluation of in vivo CLSM data, image acquisition and quantitative analysis should be optimised for the everyday clinical practice.
Highlights
The most common long-term complication of diabetes mellitus is diabetic neuropathy (DN) [1]
The patients with diabetes were further classified into 2 groups, based on the presence (DR) or absence (NDR) of diabetic retinopathy (DR), as assessed by ophthalmoscopy and sevenstandard field stereoscopic 30u fundus photography (Nikon NF505, Nikon Corporation, Tokyo, Japan) (Table 2)
The diabetic patients were stratified in 2 subgroups: with (DR, n = 7) and without (NDR, n = 11) diabetic retinopathy
Summary
The most common long-term complication of diabetes mellitus is diabetic neuropathy (DN) [1]. Most common type of DN is peripheral neuropathy, called distal peripheral neuropathy (DPN), which represents 50% of diabetic neuropathy cases [4]. DPN affects nerve cells associated with the peripheral nervous system. DPN is primarily characterized by the loss of protective limb mechanical sensations. This can potentially lead to traumatic ulceration and amputation, primarily in the foot [5]. DPN can progress to cardiac autonomic nerves, threatening mortality. The alterations of subbasal nerve plexus (SBP) innervation and corneal sensation were estimated noninvasively and compared with the values in healthy volunteers. This study addressed the relation of SBP changes to the retinal status, glycemic control and diabetes duration
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
