Abstract

Small fiber neuropathy (SFN) is a common feature of many inflammatory diseases, often presenting with pain and disability. SFN is diagnosed using symptoms, thermal threshold testing, and intra-epidermal nerve fiber quantification. Corneal confocal microscopy (CCM) is an ophthalmic imaging technique which non-invasively quantifies corneal nerve fiber (CNF) density, branch density and length, and has comparable diagnostic and superior ability to identify nerve regeneration compared to skin biopsy. CNF size (width and area) depends upon the number of fibers within each nerve, as well as pathology (e.g., swelling), and may provide additional sensitivity to diagnose SFN and identify nerve repair. We have compared the utility of the standard CCM variables employed to CNF size in patients with diabetic sensorimotor polyneuropathy or sarcoidosis-associated SFN, and in patients with SFN following cibinetide administration, an agent which promotes nerve repair. The results show that: 1) CNF width distribution and area depend upon neuropathy severity; 2) CNF area, density, branch density and length possess comparable discriminatory power for diagnosing neuropathy; 3) CNF area is related to length by a quadratic function which is predictive for both healthy subjects and those with SFN; 4) CNF area is a useful variable for quantifying change in CNF morphology.

Details

Title
Corneal nerve fiber size adds utility to the diagnosis and assessment of therapeutic response in patients with small fiber neuropathy
Author
Brines, Michael 1   VIAFID ORCID Logo  ; Culver, Daniel A 2 ; Ferdousi, Maryam 3 ; Tannemaat, Martijn R 4 ; Monique van Velzen 5   VIAFID ORCID Logo  ; Dahan, Albert 5 ; Malik, Rayaz A 6 

 Araim Pharmaceuticals, Tarrytown, NY, USA 
 Pulmonary Medicine, Cleveland Clinic, Cleveland, OH, USA 
 Divison of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom 
 Neurology, Leiden University Medical Center, Leiden, The Netherlands 
 Anesthesiology, Leiden University Medical Center, Leiden, The Netherlands 
 Weill Cornell Medicine-Qatar, Doha, Qatar 
Pages
1-11
Publication year
2018
Publication date
Mar 2018
Publisher
Nature Publishing Group
e-ISSN
20452322
Source type
Scholarly Journal
Language of publication
English
ProQuest document ID
2014513972
Copyright
© 2018. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.