Abstract
In vivo confocal microscopy (IVCM) of the living human cornea offers the ability to perform repeated imaging without tissue damage. Studies using corneal IVCM have led to significant contributions to scientific and clinical knowledge of the living cornea in health and pathological states. Recently the application of corneal IVCM beyond ophthalmology to wider clinical and research fields has been demonstrated. Abnormalities of the corneal subbasal nerve plexus have been associated with many forms of peripheral neuropathy and Langerhans cells correlate with systemic inflammatory states. There is a rapidly growing evidence base investigating the use of corneal IVCM in many systemic conditions and a well-established evidence base for IVCM imaging of the corneal subbasal plexus in diabetic peripheral neuropathy. This paper reviews the potential use of corneal IVCM in general clinical practice as a noninvasive method of assessing peripheral neuropathies, monitoring inflammatory states and clinical therapeutic response.
Highlights
The cornea is the most densely innervated tissue in the body [1]
Living human corneal nerves can be imaged noninvasively using in vivo confocal microscopy (IVCM) (Figure 1) [3,4,5,6]
Three different modes of IVCM have been developed: laser scanning confocal microscopy, slit-scanning confocal microscopy, and tandem scanning confocal microscopy [3,4,5]. These modes vary in terms of light emission, magnification, contrast, and resolution but all offer the ability to repeatedly examine the same cornea without tissue damage
Summary
The cornea is the most densely innervated tissue in the body [1]. The cranial nerves, with the exception of the optic nerve, are considered to be a part of the peripheral nervous system, with all the sensory nerves being derived from neural crest cells during embryology [2]. IVCM has been widely utilized in clinical practice in corneal and ocular surface imaging It is used as an aid in the diagnosis of Acanthamoeba keratitis, in the assessment of keratoconus, dry eyes, and contact lens wear [5]. As well as enabling imaging of corneal pathology, IVCM is increasingly being investigated for its potential to evaluate systemic disease. Studies using this technique have demonstrated corneal subbasal nerve changes that correlate with peripheral neuropathies such as diabetic peripheral neuropathy, idiopathic small fibre neuropathy, Fabry disease, and HIV associated peripheral neuropathy (Table 1) [7,8,9,10,11,12,13]. This review aims to explore IVCM’s potential use in clinical diagnosis, monitoring disease progression, and therapeutic response in current standard clinical practice and in clinical trials of novel treatments, thereby contributing to clinical knowledge and informed clinical decision making
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