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Corneal confocal microscopy identifies a reduction in corneal keratocyte density and sub-basal nerves in children with type 1 diabetes mellitus
  1. Hoda Gad1,
  2. Bara Al-Jarrah2,
  3. Saras Saraswathi2,
  4. Sara Mohamed1,
  5. Alise Kalteniece3,
  6. Ioannis N Petropoulos1,
  7. Adnan Khan1,
  8. Georgios Ponirakis1,
  9. Parul Singh4,
  10. Souhaila Al Khodor4,
  11. Mamoun Elawad2,
  12. Wesam Almasri2,
  13. Mohamed A Hendaus5,
  14. Anthony K Akobeng2,
  15. Khalid Hussain6,
  16. Rayaz A Malik1,3
  1. 1Department of Medicine, Weill Cornell Medicine, Doha, Qatar
  2. 2Gastroenterology, Sidra Medicine, Doha, Qatar
  3. 3Cardiovascular Medicine, University of Manchester, Manchester, UK
  4. 4Research, Sidra Medicine, Doha, Qatar
  5. 5General Pediatrics, Sidra Medicine, Doha, Qatar
  6. 6Endocrinology, Sidra Medicine, Doha, Qatar
  1. Correspondence to Professor Rayaz A Malik, Department of Medicine, Weill Cornell Medicine, Doha, Qatar; ram2045{at}qatar-med.cornell.edu

Abstract

Purpose To assess whether alterations in stromal keratocyte density are related to loss of corneal nerve fibres in children with type 1 diabetes mellitus (T1DM).

Methods Twenty participants with T1DM and 20 age-matched healthy controls underwent corneal confocal microscopy. Corneal sub-basal nerve morphology and corneal keratocyte density (KD) were quantified.

Results Corneal nerve fibre density (CNFD) (p<0.001), corneal nerve branch density (p<0.001), corneal nerve fibre length (CNFL) (p<0.001) and inferior whorl length (IWL) (p<0.001) were lower in children with T1DM compared with healthy controls. Anterior (p<0.03) and mid (p=0.03) stromal KDs were lower with no difference in posterior KD (PKD) in children with T1DM compared with controls. Age, duration of diabetes, height, weight and body mass index did not correlate with anterior (AKD), mid (MKD) or PKD. Inverse correlations were found between glycated haemoglobin and PKD (r=−0.539, p=0.026), bilirubin with MKD (r=−0.540, p=0.025) and PKD (r=−0.531, p=0.028) and 25-hydroxycholecalciferol with MKD (r=−0.583, p=0.018). CNFD, CNFL and IWL did not correlate with AKD, MKD or PKD.

Conclusion This study demonstrates a reduction in corneal nerves and anterior and mid stromal KD in children with T1DM, but no correlation between corneal nerve and keratocyte cell loss.

  • cornea
  • child health (paediatrics)

Data availability statement

Data are available upon reasonable request. Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request. Data are available upon reasonable request.

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Footnotes

  • Contributors All the authors met the criteria of contributorship. Study design: RAM. Data collection: HG, BA-J, SS, INP, AKal, GP, PS, SAK, ME, WA, MAH, AKA and KH. Data preparation and analysis: HG, SM and AKha. Drafting of the manuscript: HG and RAM. Critical revision of the manuscript: All authors.

  • Funding This publication was made possible by a grant from the Sidra Internal Research Fund (SIRF) and a Biomedical Research Program (BMRP- 5726113101) grant from the Qatar National Research Fund (QNRF).

  • Competing interests None declared.

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

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