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Reproducibility of in vivo corneal confocal microscopy as a novel screening test for early diabetic sensorimotor polyneuropathy.
Diabet Med. 2011 Oct; 28(10):1253-60.DM

Abstract

AIM

With the goal of identifying a valid biomarker of early diabetic sensorimotor polyneuropathy, we aimed to identify the most reliable in vivo corneal confocal microscopy (CCM) parameter for detection of abnormality of small nerve fibre morphology.

METHODS

Cross-sectional examination of 46 subjects (26 with Type 1 diabetes and 20 healthy volunteers) examined by corneal confocal microscopy for intra- and interobserver reproducibility by the intraclass correlation coefficient method. Corneal nerve fibre density, nerve branch density, nerve fibre length and tortuosity were measured on the same day that subjects underwent clinical and electrophysiological examination.

RESULTS

The 26 subjects with Type 1 diabetes had mean age and diabetes duration 42.8 ± 16.9 and 22.7 ± 16.4 years, respectively. Twelve of those subjects (46%) did not meet criteria for diabetic sensorimotor polyneuropathy, while five (19%) had mild, three (12%) had moderate and six (23%) had severe diabetic sensorimotor polyneuropathy. None of the healthy volunteers (mean age 41.4 ± 17.3 years) had polyneuropathy. Re-examination of selected corneal confocal microscopy images or sets of 40 images yielded very good to excellent intraclass correlation coefficients for all parameters. However, only one parameter (corneal nerve fibre length) emerged with consistently very good reproducibility using a clinically relevant 'study-level' protocol of subject re-examination (intra-observer intraclass correlation coefficient 0.72; interobserver intraclass correlation coefficient 0.73). Despite no differences in intraclass correlation coefficient between subgroups, corneal nerve fibre length was significantly lower (14.76 vs. 16.15 mm/mm(2), P = 0.04) in those with diabetes.

CONCLUSIONS

Development of corneal confocal microscopy may need to focus on the measurement of corneal nerve fibre length, as it appears to have superior reliability in comparison with other parameters, and as evidence exists for its potential as a clinical biomarker of early diabetic sensorimotor polyneuropathy.

Authors+Show Affiliations

Division of Endocrinology and Metabolism Division of Neurology, University of Toronto, Toronto, ON, Canada.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

21434993

Citation

Hertz, P, et al. "Reproducibility of in Vivo Corneal Confocal Microscopy as a Novel Screening Test for Early Diabetic Sensorimotor Polyneuropathy." Diabetic Medicine : a Journal of the British Diabetic Association, vol. 28, no. 10, 2011, pp. 1253-60.
Hertz P, Bril V, Orszag A, et al. Reproducibility of in vivo corneal confocal microscopy as a novel screening test for early diabetic sensorimotor polyneuropathy. Diabet Med. 2011;28(10):1253-60.
Hertz, P., Bril, V., Orszag, A., Ahmed, A., Ng, E., Nwe, P., Ngo, M., & Perkins, B. A. (2011). Reproducibility of in vivo corneal confocal microscopy as a novel screening test for early diabetic sensorimotor polyneuropathy. Diabetic Medicine : a Journal of the British Diabetic Association, 28(10), 1253-60. https://doi.org/10.1111/j.1464-5491.2011.03299.x
Hertz P, et al. Reproducibility of in Vivo Corneal Confocal Microscopy as a Novel Screening Test for Early Diabetic Sensorimotor Polyneuropathy. Diabet Med. 2011;28(10):1253-60. PubMed PMID: 21434993.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Reproducibility of in vivo corneal confocal microscopy as a novel screening test for early diabetic sensorimotor polyneuropathy. AU - Hertz,P, AU - Bril,V, AU - Orszag,A, AU - Ahmed,A, AU - Ng,E, AU - Nwe,P, AU - Ngo,M, AU - Perkins,B A, PY - 2011/3/26/entrez PY - 2011/3/26/pubmed PY - 2011/12/13/medline SP - 1253 EP - 60 JF - Diabetic medicine : a journal of the British Diabetic Association JO - Diabet Med VL - 28 IS - 10 N2 - AIM: With the goal of identifying a valid biomarker of early diabetic sensorimotor polyneuropathy, we aimed to identify the most reliable in vivo corneal confocal microscopy (CCM) parameter for detection of abnormality of small nerve fibre morphology. METHODS: Cross-sectional examination of 46 subjects (26 with Type 1 diabetes and 20 healthy volunteers) examined by corneal confocal microscopy for intra- and interobserver reproducibility by the intraclass correlation coefficient method. Corneal nerve fibre density, nerve branch density, nerve fibre length and tortuosity were measured on the same day that subjects underwent clinical and electrophysiological examination. RESULTS: The 26 subjects with Type 1 diabetes had mean age and diabetes duration 42.8 ± 16.9 and 22.7 ± 16.4 years, respectively. Twelve of those subjects (46%) did not meet criteria for diabetic sensorimotor polyneuropathy, while five (19%) had mild, three (12%) had moderate and six (23%) had severe diabetic sensorimotor polyneuropathy. None of the healthy volunteers (mean age 41.4 ± 17.3 years) had polyneuropathy. Re-examination of selected corneal confocal microscopy images or sets of 40 images yielded very good to excellent intraclass correlation coefficients for all parameters. However, only one parameter (corneal nerve fibre length) emerged with consistently very good reproducibility using a clinically relevant 'study-level' protocol of subject re-examination (intra-observer intraclass correlation coefficient 0.72; interobserver intraclass correlation coefficient 0.73). Despite no differences in intraclass correlation coefficient between subgroups, corneal nerve fibre length was significantly lower (14.76 vs. 16.15 mm/mm(2), P = 0.04) in those with diabetes. CONCLUSIONS: Development of corneal confocal microscopy may need to focus on the measurement of corneal nerve fibre length, as it appears to have superior reliability in comparison with other parameters, and as evidence exists for its potential as a clinical biomarker of early diabetic sensorimotor polyneuropathy. SN - 1464-5491 UR - https://www.unboundmedicine.com/medline/citation/21434993/Reproducibility_of_in_vivo_corneal_confocal_microscopy_as_a_novel_screening_test_for_early_diabetic_sensorimotor_polyneuropathy_ L2 - https://doi.org/10.1111/j.1464-5491.2011.03299.x DB - PRIME DP - Unbound Medicine ER -