Reduced corneal nerve fibre length in prediabetes and type 2 diabetes: the Maastricht Study

Eline E.B. de Clerck (Corresponding author), Jan S.A.G. Schouten, Tos T.J.M. Berendschot, Renée S. Koolschijn, Rudy M.M.A. Nuijts, Miranda T. Schram, Nicolaas C. Schaper, Ronald M.A. Henry, Pieter C. Dagnelie, Alfredo Ruggeri, Pedro Guimarães, Coen D.A. Stehouwer, Carroll A.B. Webers

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Purpose: In individuals with diabetes, injury to the corneal nerve fibres predisposes to delayed corneal epithelial healing, reduced corneal sensitivity and corneal erosion. We investigated to what extent a reduction in corneal nerve fibre length (CNFL) is present in individuals with prediabetes or type 2 diabetes (DM2) compared with individuals with normal glucose metabolism (NGM). Methods: Using composite images acquired by corneal confocal microscopy, we assessed total CNFL per mm2 in the subbasal nerve plexus of the cornea in 134 participants (mean age 59 ± 8 years, 49% men, 87 NGM, 20 prediabetes, 27 DM2). Multivariable linear regression was used to assess the association between CNFL and glucose metabolism status, adjusted for age and sex. Results: In individuals with type 2 diabetes, the mean CNFL was significantly reduced [β = −1.86 mm/mm2 (95% CI −3.64 to −0.08), p = 0.04], as compared with individuals with normal glucose metabolism after adjustment for age and sex. Part of the reduction was present in individuals with prediabetes [β = −0.96 mm/mm2 (95% CI −2.91 to 0.99), p = 0.34], with a linear trend of corneal nerve fibre reduction with severity of glucose metabolism status (p trend = 0.04). Conclusions: A significant reduction in CNFL was found in individuals with DM2 compared with individuals with NGM. A trend of reduction in CNFL was observed between individuals with NGM and prediabetes. The reduction in corneal nerve fibre length could contribute to a delayed corneal healing and an increased risk for corneal complications after surgery.

Original languageEnglish
Pages (from-to)485-491
Number of pages7
JournalActa Ophthalmologica
Issue number5
Early online date3 Feb 2020
Publication statusPublished - 1 Aug 2020


  • corneal confocal microscopy
  • corneal nerves
  • type 2 diabetes
  • prediabetes

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