Corneal Confocal Microscopy abnormalities in children and adolescents with Type 1 Diabetes.

Overview

INTRODUCTION: Utility of corneal confocal microscopy (CCM) in children and adolescents with type 1 diabetes mellitus (T1DM) without neuropathic symptoms or signs and minimal abnormality in large and small nerve fibre function tests remains largely undetermined. RESEARCH DESIGN AND METHODS: A cohort of children and adolescents with T1DM (n=51) and healthy controls (n=50) underwent evaluation for symptoms and signs of neurological deficits, including warm detection threshold (WDT), cold detection threshold (CDT), vibration perception threshold (VPT), nerve conduction studies (NCS) and CCM. RESULTS: Children with T1DM had no or very minimal neuropathic symptoms and deficits based on the Toronto Clinical Neuropathy Score (TCNS), yet NCS abnormalities were present in 18 (35%), small fibre dysfunction (SFD) defined by an abnormal Thermal Detection Threshold (TDT) was found in 13 (25.5%) and CCM abnormalities were present in 25 (49%). CCM was abnormal in a majority of T1DM children with abnormal TDT (12/13, 92%) and abnormal NCS (16/18, 88%). CCM additionally was able to detect small fibre abnormalities in 13/38 (34%) in T1DM with a normal TDT and in 9/33 (27%) with normal NCS. CONCLUSIONS: CCM was able to detect corneal nerve loss in children with and without abnormalities in thermal detection thresholds and NCS.