Abstract
Optical coherence tomography (OCT) of the retina and corneal confocal laser scanning microscopy (CLSM) of the subbasal nerve plexus (SBP) are noninvasive techniques for quantification of the ocular neurodegenerative changes in individuals with type 1 diabetes mellitus (T1DM). In adult T1DM patients these changes are hardly related to T1DM only. Instead, ageing and/or lifestyle associated comorbidities have to be considered as putative confounding variables. Therefore, we investigated pediatric T1DM patients (n = 28; 14.2 ± 2.51 y; duration of disease: 5.39 ± 4.16 y) without clinical signs of diabetic retina disease, neuropathy, vasculopathy or nephropathy and compared our findings with those obtained in healthy controls (n = 46; 14.8 ± 1.89 y). The SBP was characterized by the averaged length, thickness, and tortuosity of nerve fibers as well as the number of branching and connecting points. OCT was used to determine the total thickness of the retina (ALL) and the thickness of each retinal layer. Both methods revealed signs of early neurodegenerative changes, e.g. thinning of distinct retinal layers at the pericentral ring and shortening of corneal nerve fibers that are already present in pediatric T1DM patients. Standardization of instruments and algorithms are urgently required to enable uniform comparison between different groups and define normative values to introduce in the clinical setting.
Highlights
Type 1 diabetes mellitus (T1DM) is one of the most common metabolic disorders in childhood and affects nearly 15 million children worldwide[1]
While anthropometric characteristics and age were fairly comparable between patients and controls, office blood pressure (BP) was significantly higher in patients compared to controls
Insulin was administered via multiple daily insulin injections (MDI) to 16 (15) patients and via continuous subcutaneous insulin infusion (CSII) to 12 (11) patients undergoing confocal laser scanning microscopy (CLSM) and Optical coherence tomography (OCT), respectively
Summary
Type 1 diabetes mellitus (T1DM) is one of the most common metabolic disorders in childhood and affects nearly 15 million children worldwide[1]. Contrasting with the rather high sensitivity of the retina towards metabolic changes, virtually all forms of retinopathies remain asymptomatic for a long time[3]. Optical coherence tomography (OCT) was introduced as a powerful tool for imaging and quantitative analysis of the retina[8]. OCT revealed distinct but significant thinning of retinal layers in adults as well as adolescents and young adults suffering from T1DM3,9. Quantitative analysis of CLSM images is still a challenging task as it requires sophisticated software tools to describe the SBP in terms of nerve fiber length, density, connectivity and tortuosity[7,14,19,20,21]
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