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Bilateral morphometric analysis of corneal sub-basal nerve plexus in patients undergoing unilateral cataract surgery: a preliminary in vivo confocal microscopy study
  1. Giuseppe Giannaccare1,
  2. Federico Bernabei2,
  3. Marco Pellegrini2,
  4. Fabio Guaraldi2,
  5. Federica Turchi2,
  6. Carlo Torrazza2,
  7. Carlotta Senni2,
  8. Riccardo Scotto3,
  9. Daniele Sindaco3,
  10. Luca Di Cello3,
  11. Piera Versura2,
  12. Vincenzo Scorcia1,
  13. Carlo E Traverso4,
  14. Aldo Vagge3
  1. 1 Department of Ophthalmology, University Magna Græcia of Catanzaro, Catanzaro, Italy
  2. 2 Ophthalmology Unit, S.Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
  3. 3 Department of Neuroscience Rehabilitation Ophthalmology Genetics and Maternal and Child Health Genova, University of Genoa, Genova, Italy
  4. 4 Di.N.O.G, Centro di Ricerca Clinica e Laboratorio per il Glaucoma e la Cornea, Eye Clinic, Genova, Italy
  1. Correspondence to Dr Giuseppe Giannaccare, Department of Ophthalmology, University Magna Græcia of Catanzaro, Catanzaro 88100, Italy; giuseppe.giannaccare{at}


Aims To evaluate bilateral morphometric changes of corneal sub-basal nerve plexus (CSNP) occurring after unilateral cataract surgery by in vivo confocal microscopy (IVCM) images analysed with automated software.

Methods IVCM was performed before (V0) and 1 month after surgery (V1) in both operated eyes (OEs) and unoperated eyes (UEs) of 30 patients. Thirty age and sex-matched subjects acted as controls. Corneal nerve fibre density (CNFD), corneal nerve branch density (CNBD), corneal nerve fibre length (CNFL), corneal nerve total branch density (CTBD), corneal nerve fibre area (CNFA), corneal nerve fibre width, corneal nerve fractal dimension (CNFrD) and dendritic cells density were calculated.

Results Mean CNFD, CNBD, CNFL, CTBD, CNFA and CNFrD significantly decreased at V1 versus V0 in both eyes (respectively, 15.35±7.00 vs 21.21±6.56 n/mm2 in OEs and 20.11±6.69 vs 23.20±7.26 in UEs; 13.57±12.16 vs 26.79±16.91 n/mm2 in OEs and 24.28±14.88 vs 29.76±15.25 in UEs; 9.67±3.44 mm/mm2 vs 13.49±3.42 in OEs and 12.53±3.60 vs 14.02±3.82 in UEs; 22.81±18.77 vs 42.25±24.64 n/mm2 in OEs and 38.06±20.52 vs 43.93±22.27 in UEs; 0.0040±0.0021 vs 0.0058±0.0020 mm2/mm2 in OEs and 0.0049±0.0016 vs 0.0057±0.0019 in UEs; 1.418±0.058 vs 1.470±0.037 in OEs and 1.466±0.040 vs 1.477±0.036 in UEs; always p<0.049).

Conclusion Patients undergoing cataract surgery exhibit bilateral alterations of CSNP. This finding could have broad implications in the setting of sequential cataract surgery.

  • cornea
  • imaging
  • diagnostic tests/investigation

Statistics from


  • Contributors GG, VS and AV designed the study. FG and FT recruited the patients. DS evaluated corneal sensitivity. RS made the in vivo confocal microscopy examination. DS and LDC selected the images. CET and RS did cataract surgery procedures. FB analysed the images with ACCmetrics. MP and CS did the statistical analysis. PV and CET supervised the work. GG wrote the draft. All the authors reviewed the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was carried out in accordance with the Declaration of Helsinki and received approval of the Ethics Committee of the S. Martino University Hospital (Genoa, Italy).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. The data that support the findings of this study are available from the corresponding author (GG), upon reasonable request.

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