Journal of diabetes investigation | 2021
Corneal confocal microscopy for the diagnosis of diabetic peripheral neuropathy: A systematic review and meta-analysis.
Abstract
INTRODUCTION\nCorneal confocal microscopy (CCM) is a rapid non-invasive ophthalmic imaging technique that identifies corneal nerve fibre damage. Small studies suggest that CCM could be used to assess patients with diabetic peripheral neuropathy (DPN).\n\n\nAIM\nTo undertake a systematic review and meta-analysis assessing the diagnostic utility of CCM for sub-clinical DPN (DPN- ) and established DPN (DPN+ ).\n\n\nDATA SOURCES\nDatabases (PubMed, Embase, Central, ProQuest) were searched for studies using CCM in patients with diabetes up to April 2020.\n\n\nSTUDY SELECTION\nStudies were included if they reported on at least one CCM parameter in patients with diabetes.\n\n\nDATA EXTRACTION\nCorneal 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.\n\n\nDATA SYNTHESIS\nThirty-eight studies including ~4000 participants were included in this meta-analysis. There were significant reductions in CNFD, CNBD, CNFL and IWL in DPN- vs. controls (P<0.00001), DPN+ vs. controls (P<0.00001) and DPN+ vs. DPN- (P<0.00001).\n\n\nCONCLUSION\nThis systematic review and meta-analysis shows that CCM detects small nerve fibre loss in subclinical and clinical DPN and concludes that CCM has good diagnostic utility in DPN.