title: Corneal nerve tortuosity in diabetic patients with neuropathy.
abstract: OBJECTIVE
  Corneal confocal microscopy is a reiterative, rapid, noninvasive in vivo clinical examination technique capable of imaging corneal nerve fibers. Nerve fiber tortuosity may indicate a degenerative and attempted regenerative response of nerve fibers to diabetes. The purpose of this study was to define alterations in the tortuosity of corneal nerve fibers in relation to age, duration of diabetes, glycemic control, and neuropathic severity.
  
  
  METHODS
  The cornea and collected images of the subbasal nerve plexus of 18 diabetic patients (stratified into mild, moderate, and severe neuropathic groups using conventional clinical measures of neuropathy) and 18 age-matched nondiabetic control subjects were scanned, and a novel mathematical paradigm was applied to quantify the extent of nerve tortuosity, which was termed the tortuosity coefficient (TC).
  
  
  RESULTS
  TC was significantly different between the four clinical groups (F(3) = 12.2, P < 0.001). It was significantly greater in the severe neuropathic group than in control subjects (P < 0.003) and in the mild (P < 0.004) and moderate (P < 0.01) neuropathic groups. TC did not correlate significantly with the age (r = -0.003, P > 0.05), duration of diabetes (r = -0.219, P > 0.05), or hemoglobin A1c (HbA1c; r = 0.155, P > 0.05) of diabetic patients.
  
  
  CONCLUSIONS
  Corneal confocal microscopy allows rapid, noninvasive in vivo evaluation of corneal nerve tortuosity. This morphologic abnormality relates to the severity of somatic neuropathy and may reflect an alteration in the degree of degeneration and regeneration in diabetes.
authors.affiliation: Eurolens Research, Department of Optometry and Neuroscience, University of Manchester Institute of Science and Technology, Manchester, United Kingdom.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Kallinikos
authors.forename: Michael
authors.initials: M
authors.lastname: Berhanu
authors.forename: Clare
authors.initials: C
authors.lastname: O'Donnell
authors.forename: Andrew J M
authors.initials: AJ
authors.lastname: Boulton
authors.forename: Nathan
authors.initials: N
authors.lastname: Efron
authors.forename: Rayaz A
authors.initials: RA
authors.lastname: Malik
mesh_terms: D003315:Cornea / Q000294:innervation*; D003389:Cranial Nerve Diseases / Q000473:pathology*; D003920:Diabetes Mellitus / Q000473:pathology*; D003929:Diabetic Neuropathies / Q000473:pathology*; D006801:Humans; D018613:Microscopy, Confocal; D008875:Middle Aged; D009412:Nerve Fibers / Q000473:pathology; D009882:Ophthalmic Nerve / Q000473:pathology*