Eine klinisch experimentelle Querschnittstudie zur Charakterisierung des subbasalen Nervenplexus der Kornea: Untersuchung von gesunden Kindern und Jugendlichen sowie von pädiatrischen Patienten mit einem Typ 1 Diabetes mellitus oder einer chronischen Niereninsuffizienz

Die diabetische und urämische Polyneuropathie sind häufige und schwer therapierbare Folgeerkrankungen eines Diabetes mellitus bzw. einer chronischen Nierenerkrankung. Die Konfokale-Laser-Scanning-Mikroskopie ist ein objektives und nichtinvasives Messverfahren, welches es ermöglicht den subbasalen Nervenplexus der Kornea darzustellen. Bereits bei Kindern und Jugendlichen mit einem Diabetes mellitus Typ I oder einer chronischen Nierenerkrankung ohne polyneuropathischen Symptomen sind mit dieser Methode Veränderungen des kornealen Nervenplexus zu erfassen

The corneal subbasal nerve plexus and thickness of the retinal layers in pediatric type 1 diabetes and matched controls

Optical coherence tomography (OCT) of the retina and corneal confocal laser scanning microscopy (CLSM) of the subbasal nerve plexus (SBP) are noninvasive techniques for quantification of the ocular neurodegenerative changes in individuals with type 1 diabetes mellitus (T1DM). In adult T1DM patients these changes are hardly related to T1DM only. Instead, ageing and/or lifestyle associated comorbidities have to be considered as putative confounding variables. Therefore, we investigated pediatric T1DM patients (n = 28; 14.2 ± 2.51 y; duration of disease: 5.39 ± 4.16 y) without clinical signs of diabetic retina disease, neuropathy, vasculopathy or nephropathy and compared our findings with those obtained in healthy controls (n = 46; 14.8 ± 1.89 y). The SBP was characterized by the averaged length, thickness, and tortuosity of nerve fibers as well as the number of branching and connecting points. OCT was used to determine the total thickness of the retina (ALL) and the thickness of each retinal layer. Both methods revealed signs of early neurodegenerative changes, e.g. thinning of distinct retinal layers at the pericentral ring and shortening of corneal nerve fibers that are already present in pediatric T1DM patients. Standardization of instruments and algorithms are urgently required to enable uniform comparison between different groups and define normative values to introduce in the clinical setting