Corneal confocal microscopy for the diagnosis of diabetic peripheral neuropathy: A systematic review and meta‐analysis

ABSTRACT Introduction Corneal confocal microscopy (CCM) is a rapid non‐invasive ophthalmic imaging technique that identifies corneal nerve fiber damage. Small studies suggest that CCM could be used to assess patients with diabetic peripheral neuropathy (DPN). Aim To undertake a systematic review and...

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Bibliographic Details
Published in:Journal of diabetes investigation 2022-01, Vol.13 (1), p.134-147
Main Authors: Gad, Hoda, Petropoulos, Ioannis N, Khan, Adnan, Ponirakis, Georgios, MacDonald, Ross, Alam, Uazman, Malik, Rayaz A
Format: Article
Language:English
Subjects:
Adult
Aged
Bias
CCM
Confocal microscopy
Cornea
Cornea - diagnostic imaging
Cornea - innervation
Diabetes
Diabetes mellitus
Diabetic Neuropathies - diagnosis
Diabetic neuropathy
Diabetic peripheral neuropathy
Diagnosis
Female
Humans
Male
Meta-analysis
Microscopy
Microscopy, Confocal - methods
Microscopy, Confocal - statistics & numerical data
Middle Aged
Nerve Fibers - pathology
Original
Patients
Peripheral neuropathy
Predictive Value of Tests
Reproducibility of Results
Software
Subject heading schemes
Systematic review
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Summary:ABSTRACT Introduction Corneal confocal microscopy (CCM) is a rapid non‐invasive ophthalmic imaging technique that identifies corneal nerve fiber damage. Small studies suggest that CCM could be used to assess patients with diabetic peripheral neuropathy (DPN). Aim To undertake a systematic review and meta‐analysis assessing the diagnostic utility of CCM for sub‐clinical DPN (DPN−) and established DPN (DPN+). Data sources Databases (PubMed, Embase, Central, ProQuest) were searched for studies using CCM in patients with diabetes up to April 2020. Study selection Studies were included if they reported on at least one CCM parameter in patients with diabetes. Data extraction Corneal nerve fiber density (CNFD), corneal nerve branch density (CNBD), corneal nerve fiber length (CNFL), and inferior whorl length (IWL) were compared between patients with diabetes with and without DPN and controls. Meta‐analysis was undertaken using RevMan V.5.3. Data synthesis Thirty‐eight studies including ~4,000 participants were included in this meta‐analysis. There were significant reductions in CNFD, CNBD, CNFL, and IWL in DPN− vs controls (P 
ISSN:2040-1116
2040-1124
DOI:10.1111/jdi.13643