ArticleInvestigative ophthalmology & visual science2015
The Inferior Whorl For Detecting Diabetic Peripheral Neuropathy Using Corneal Confocal Microscopy.
Article in Investigative ophthalmology & visual science, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 54 papers, 3 of them syntheses that pooled it.
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Who cites it
54 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Corneal confocal microscopy for the diagnosis of diabetic peripheral neuropathy: A systematic review and meta-analysis.Journal of diabetes investigation · 2022Pooled it
- Altered pain processing in patients with type 1 and 2 diabetes: systematic review and meta-analysis of pain detection thresholds and pain modulation mechanisms.BMJ open diabetes research & care · 2020Pooled it
- A systematic review on the impact of diabetes mellitus on the ocular surface.Nutrition & diabetes · 2017Pooled it
- Using corneal confocal microscopy to compare Mecobalamin intramuscular injections vs oral tablets in treating diabetic peripheral neuropathy: a RCT.Scientific reports · 2021Trial
- Effects of Sitagliptin and Celery Seed Extract on Corneal Nerve Morphology and Sensory Dysfunction in Diabetic Rats.Nutrients · 2026Article
- Deep Learning-Assisted Differentiation of Four Peripheral Neuropathies Using Corneal Confocal Microscopy.Annals of clinical and translational neurology · 2026Article
- Applications of Artificial Intelligence in Corneal Nerve Images in Ophthalmology.Diagnostics (Basel, Switzerland) · 2026Review
- Methods for the evaluation of corneal nerve fibres in diabetes mellitus by in vivo confocal microscopy: a scoping review.BMJ open · 2025Article
- Bibliometric Analysis: Insights Into the Podiatric Medicine Landscape of Diabetic Sensory Peripheral Neuropathy and Genomics.Journal of foot and ankle research · 2025Article
- Corneal nerve abnormalities in early-stage diabetic retinopathy evaluated by corneal confocal microscopy.BMC ophthalmology · 2025Article
- Quantifying the Corneal Nerve Whorl Pattern.Translational vision science & technology · 2024Article
- Deep-learning based analysis of in-vivo confocal microscopy images of the subbasal corneal nerve plexus' inferior whorl in patients with neuropathic corneal pain and dry eye disease.The ocular surface · 2024Article
- Evaluation of Microvascular Complications in Kidney Recipients With Posttransplant Diabetes Mellitus.The Journal of clinical endocrinology and metabolism · 2024Article
- Correlation Between Corneal Whorl-Like Nerve and Retinal Neurodegenerative Changes and Their Association With Microvessel Perfusion in Diabetes.Investigative ophthalmology & visual science · 2023Article
- Occurrence of corneal sub-epithelial microneuromas and axonal swelling in people with diabetes with and without (painful) diabetic neuropathy.Diabetologia · 2023Article
- Type 2 diabetes influences intraepithelial corneal nerve parameters and corneal stromal-epithelial nerve penetration sites.Journal of diabetes investigation · 2023Article
- Corneal dendritic cells in diabetes mellitus: A narrative review.Frontiers in endocrinology · 2023Review
- Impact of Chronic Kidney Disease on Corneal Neuroimmune Features in Type 2 Diabetes.Journal of clinical medicine · 2022Article
- Article
- Artificial Intelligence and Corneal Confocal Microscopy: The Start of a Beautiful Relationship.Journal of clinical medicine · 2022Review
Corrections and comments
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Authors and funding
10 authors.
Funding
Abstract
purposeIn vivo corneal confocal microscopy (CCM) is increasingly used as a surrogate endpoint in studies of diabetic polyneuropathy (DPN). However, it is not clear whether imaging the central cornea provides optimal diagnostic utility for DPN. Therefore, we compared nerve morphology in the central cornea and the inferior whorl, a more distal and densely innervated area located inferior and nasal to the central cornea.
methodsA total of 53 subjects with type 1/type 2 diabetes and 15 age-matched control subjects underwent detailed assessment of neuropathic symptoms (NPS), deficits (neuropathy disability score [NDS]), quantitative sensory testing (vibration perception threshold [VPT], cold and warm threshold [CT/WT], and cold- and heat-induced pain [CIP/HIP]), and electrophysiology (sural and peroneal nerve conduction velocity [SSNCV/PMNCV], and sural and peroneal nerve amplitude [SSNA/PMNA]) to diagnose patients with (DPN+) and without (DPN-) neuropathy. Corneal nerve fiber density (CNFD) and length (CNFL) in the central cornea, and inferior whorl length (IWL) were quantified.
resultsComparing control subjects to DPN- and DPN+ patients, there was a significant increase in NDS (0 vs. 2.6 ± 2.3 vs. 3.3 ± 2.7, P < 0.01), VPT (V; 5.4 ± 3.0 vs. 10.6 ± 10.3 vs. 17.7 ± 11.8, P < 0.01), WT (°C; 37.7 ± 3.5 vs. 39.1 ± 5.1 vs. 41.7 ± 4.7, P < 0.05), and a significant decrease in SSNCV (m/s; 50.2 ± 5.4 vs. 48.4 ± 5.0 vs. 39.5 ± 10.6, P < 0.05), CNFD (fibers/mm2; 37.8 ± 4.9 vs. 29.7 ± 7.7 vs. 27.1 ± 9.9, P < 0.01), CNFL (mm/mm2; 27.5 ± 3.6 vs. 24.4 ± 7.8 vs. 20.7 ± 7.1, P < 0.01), and IWL (mm/mm2; 35.1 ± 6.5 vs. 26.2 ± 10.5 vs. 23.6 ± 11.4, P < 0.05). For the diagnosis of DPN, CNFD, CNFL, and IWL achieved an area under the curve (AUC) of 0.75, 0.74, and 0.70, respectively, and a combination of IWL-CNFD achieved an AUC of 0.76.
conclusionsThe parameters of CNFD, CNFL, and IWL have a comparable ability to diagnose patients with DPN. However, IWL detects an abnormality even in patients without DPN. Combining IWL with CNFD may improve the diagnostic performance of CCM.
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