Corneal nerve loss in children with type 1 diabetes mellitus without retinopathy or microalbuminuria

Abstract

Introduction/Aim Corneal confocal microscopy is a rapid, non‐invasive ophthalmic technique to identify sub‐clinical neuropathy. The aim of this study was to quantify corneal nerve morphology in children with type 1 diabetes mellitus compared to age‐matched healthy controls using corneal confocal microscopy. Method Twenty participants with type 1 diabetes mellitus (age 14±2 years, diabetes duration 4.08±2.91 years, glycated hemoglobin 9.3±2.1%) without retinopathy or microalbuminuria and 20 healthy controls were recruited from outpatient clinics. Corneal confocal microscopy was undertaken and corneal nerve fiber density (no./mm²), corneal nerve branch density (no./mm²), corneal nerve fiber length (mm/mm²), corneal nerve fiber tortuosity and inferior whorl length (mm/mm²) were quantified manually. Results Corneal nerve fiber density (22.73±8.84 vs. 32.92±8.59; P P P P P =0.323) did not differ between children with type 1 diabetes mellitus and controls. Glycated hemoglobin correlated with corneal nerve fiber tortuosity (P P =0.039), corneal nerve branch density (P =0.003), and corneal nerve fiber length (P =0.037). Conclusion Corneal confocal microscopy identifies significant sub‐clinical corneal nerve loss, especially in the inferior whorl of children with type 1 diabetes mellitus without retinopathy or microalbuminuria.