title: Early Corneal Cellular and Nerve Fiber Pathology in Young Patients With Type 1 Diabetes Mellitus Identified Using Corneal Confocal Microscopy.
abstract: OBJECTIVE
  The aim of this study was to quantify epithelial, stromal, and endothelial cell density, and subbasal nerve morphology in young patients with type 1 diabetes mellitus with and without diabetic retinopathy.
  
  
  METHODS
  A total of 28 young patients (mean age, 22.86 ± 9.05 years) with type 1 diabetes, with (n = 18) and without (n = 10) retinopathy, and 17 age-matched healthy control subjects (mean age, 26.53 ± 2.43 years) underwent corneal confocal microscopy (CCM).
  
  
  RESULTS
  We found significantly lower epithelial (P < 0.0001) and endothelial (P = 0.001) cell densities and higher keratocyte cell density (P = 0.024) in patients with type 1 diabetes compared to controls. Significantly lower corneal nerve fiber density (P = 0.004), nerve branch density (P = 0.004), total nerve branch density (P = 0.04), and nerve fiber length (P = 0.001), and greater nerve fiber width (P = 0.04) were observed in patients with type 1 diabetes compared to control subjects. Significantly lower epithelial (P < 0.001) and endothelial (P = 0.02) cell densities, nerve branch density (P = 0.02), and nerve fiber length (P = 0.04), and significantly higher keratocyte cell density (P = 0.02) were found in patients with type 1 diabetes without retinopathy compared to control subjects.
  
  
  CONCLUSIONS
  Corneal confocal microscopy identifies corneal cellular and small nerve fiber pathology in young patients with type 1 diabetes without retinopathy, which increases in severity in those with retinopathy. Corneal confocal microscopy appears to have considerable use as an imaging biomarker for early subclinical pathology in young patients with type 1 diabetes mellitus.
authors.affiliation: Department of Ophthalmology, University of Debrecen, Faculty of Medicine, Debrecen, Hungary.
authors.forename: Eszter
authors.initials: E
authors.lastname: Szalai
authors.affiliation: Department of Ophthalmology, University of Debrecen, Faculty of Medicine, Debrecen, Hungary 2Department of Biochemistry and Molecular Biology, University of Debrecen, Faculty of Medicine, Debrecen, Hungary.
authors.forename: Eszter
authors.initials: E
authors.lastname: Deák
authors.affiliation: Department of Ophthalmology, University of Debrecen, Faculty of Medicine, Debrecen, Hungary.
authors.forename: László
authors.initials: L
authors.lastname: Módis
authors.affiliation: Department of Ophthalmology, University of Debrecen, Faculty of Medicine, Debrecen, Hungary.
authors.forename: Gábor
authors.initials: G
authors.lastname: Németh
authors.affiliation: Department of Ophthalmology, University of Debrecen, Faculty of Medicine, Debrecen, Hungary.
authors.forename: András
authors.initials: A
authors.lastname: Berta
authors.affiliation: Department of Ophthalmology, University of Debrecen, Faculty of Medicine, Debrecen, Hungary.
authors.forename: Annamária
authors.initials: A
authors.lastname: Nagy
authors.affiliation: Department of Pediatrics, University of Debrecen, Faculty of Medicine, Debrecen, Hungary.
authors.forename: Eniko
authors.initials: E
authors.lastname: Felszeghy
authors.affiliation: Department of Pediatrics, University of Debrecen, Faculty of Medicine, Debrecen, Hungary.
authors.forename: Rita
authors.initials: R
authors.lastname: Káposzta
authors.affiliation: Centre for Endocrinology and Diabetes, Institute of Human Development, University of Manchester, Manchester, United Kingdom 5Weill-Cornell Medicine-Qatar, Doha, Qatar.
authors.forename: Rayaz A
authors.initials: RA
authors.lastname: Malik
authors.affiliation: Department of Ophthalmology, University of Debrecen, Faculty of Medicine, Debrecen, Hungary 63T Research Kft., Debrecen, Hungary.
authors.forename: Adrienne
authors.initials: A
authors.lastname: Csutak
mesh_terms: D000293:Adolescent; D000328:Adult; D002452:Cell Count; D003315:Cornea / Q000473:pathology*; D060527:Corneal Keratocytes / Q000473:pathology; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000473:pathology; D003930:Diabetic Retinopathy / Q000209:etiology / Q000473:pathology*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D018613:Microscopy, Confocal / Q000379:methods; D009412:Nerve Fibers / Q000473:pathology*; D011379:Prognosis; D013997:Time Factors; D055815:Young Adult