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Khan A, Kamal M, Alhothi A, Gad H, Adan MA, Ponirakis G, Petropoulos IN, Malik RA. Corneal confocal microscopy demonstrates sensory nerve loss in children with autism spectrum disorder. PLoS One 2023; 18:e0288399. [PMID: 37437060 DOI: 10.1371/journal.pone.0288399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 06/24/2023] [Indexed: 07/14/2023] Open
Abstract
Autism spectrum disorder (ASD) is a developmental disorder characterized by difficulty in communication and interaction with others. Postmortem studies have shown cerebral neuronal loss and neuroimaging studies show neuronal loss in the amygdala, cerebellum and inter-hemispheric regions of the brain. Recent studies have shown altered tactile discrimination and allodynia on the face, mouth, hands and feet and intraepidermal nerve fiber loss in the legs of subjects with ASD. Fifteen children with ASD (age: 12.00 ± 3.55 years) and twenty age-matched healthy controls (age: 12.83 ± 1.91 years) underwent corneal confocal microscopy (CCM) and quantification of corneal nerve fiber morphology. Corneal nerve fibre density (fibers/mm2) (28.61 ± 5.74 vs. 40.42 ± 8.95, p = 0.000), corneal nerve fibre length (mm/mm2) (16.61 ± 3.26 vs. 21.44 ± 4.44, p = 0.001), corneal nerve branch density (branches/mm2) (43.68 ± 22.71 vs. 62.39 ± 21.58, p = 0.018) and corneal nerve fibre tortuosity (0.037 ± 0.023 vs. 0.074 ± 0.017, p = 0.000) were significantly lower and inferior whorl length (mm/mm2) (21.06 ± 6.12 vs. 23.43 ± 3.95, p = 0.255) was comparable in children with ASD compared to controls. CCM identifies central corneal nerve fiber loss in children with ASD. These findings, urge the need for larger longitudinal studies to determine the utility of CCM as an imaging biomarker for neuronal loss in different subtypes of ASD and in relation to disease progression.
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Affiliation(s)
- Adnan Khan
- Research Division, Weill Cornell Medicine-Qatar, Doha, Qatar
- Faculty of Health Sciences, Khyber Medical University, Peshawar, Pakistan
| | - Madeeha Kamal
- Department of Pediatrics, Sidra Medicine, Doha, Qatar
| | - Abdula Alhothi
- Department of Pediatrics, Hamad General Hospital, Doha, Qatar
| | - Hoda Gad
- Research Division, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Marian A Adan
- Department of Pediatrics, Hamad General Hospital, Doha, Qatar
| | | | | | - Rayaz A Malik
- Research Division, Weill Cornell Medicine-Qatar, Doha, Qatar
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2
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Chen Z, Yin X, Lin L, Shi G, Mo J. Centerline extraction by neighborhood-statistics thinning for quantitative analysis of corneal nerve fibers. Phys Med Biol 2022; 67. [DOI: 10.1088/1361-6560/ac7b63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 06/22/2022] [Indexed: 11/11/2022]
Abstract
Abstract
Objective. Corneal nerve fiber (CNF) has been found to exhibit morphological changes associated with various diseases, which can therefore be utilized to aid in the early diagnosis of those diseases. CNF is usually visualized under corneal confocal microscopy (CCM) in clinic. To obtain the diagnostic biomarkers from CNF image produced from CCM, image processing and quantitative analysis are needed. Usually, CNF is segmented first and then CNF’s centerline is extracted, allowing for measuring geometrical and topological biomarkers of CNF, such as density, tortuosity, and length. Consequently, the accuracy of the segmentation and centerline extraction can make a big impact on the biomarker measurement. Thus, this study is aimed to improve the accuracy and universality of centerline extraction. Approach. We developed a new thinning algorithm based on neighborhood statistics, called neighborhood-statistics thinning (NST), to extract the centerline of CNF. Compared with traditional thinning and skeletonization techniques, NST exhibits a better capability to preserve the fine structure of CNF which can effectively benefit the biomarkers measurement above. Moreover, NST incorporates a fitting process, which can make centerline extraction be less influenced by image segmentation. Main results. This new method is evaluated on three datasets which are segmented with five different deep learning networks. The results show that NST is superior to thinning and skeletonization on all the CNF-segmented datasets with a precision rate above 0.82. Last, NST is attempted to be applied for the diagnosis of keratitis with the quantitative biomarkers measured from the extracted centerlines. Longer length and higher density but lower tortuosity were found on the CNF of keratitis patients as compared to healthy patients. Significance. This demonstrates that NST has a good potential to aid in the diagnostics of eye diseases in clinic.
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3
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Khan A, Parray A, Akhtar N, Agouni A, Kamran S, Pananchikkal SV, Priyanka R, Gad H, Ponirakis G, Petropoulos IN, Chen KH, Tayyab K, Saqqur M, Shuaib A, Malik RA. Corneal nerve loss in patients with TIA and acute ischemic stroke in relation to circulating markers of inflammation and vascular integrity. Sci Rep 2022; 12:3332. [PMID: 35228650 PMCID: PMC8885663 DOI: 10.1038/s41598-022-07353-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 02/14/2022] [Indexed: 12/01/2022] Open
Abstract
Vascular and inflammatory mechanisms are implicated in the development of cerebrovascular disease and corneal nerve loss occurs in patients with transient ischemic attack (TIA) and acute ischemic stroke (AIS). We have assessed whether serum markers of inflammation and vascular integrity are associated with the severity of corneal nerve loss in patients with TIA and AIS. Corneal confocal microscopy (CCM) was performed to quantify corneal nerve fiber density (CNFD), corneal nerve branch density (CNBD) and corneal nerve fiber length (CNFL) in 105 patients with TIA (n = 24) or AIS (n = 81) and age matched control subjects (n = 56). Circulating levels of IL-6, MMP-2, MMP-9, E-Selectin, P-Selectin and VEGF were quantified in patients within 48 h of presentation with a TIA or AIS. CNFL (P = 0.000, P = 0.000), CNFD (P = 0.122, P = 0.000) and CNBD (P = 0.002, P = 0.000) were reduced in patients with TIA and AIS compared to controls, respectively with no difference between patients with AIS and TIA. The NIHSS Score (P = 0.000), IL-6 (P = 0.011) and E-Selectin (P = 0.032) were higher in patients with AIS compared to TIA with no difference in MMP-2 (P = 0.636), MMP-9 (P = 0.098), P-Selectin (P = 0.395) and VEGF (P = 0.831). CNFL (r = 0.218, P = 0.026) and CNFD (r = 0.230, P = 0.019) correlated with IL-6 and multiple regression analysis showed a positive association of CNFL and CNFD with IL-6 (P = 0.041, P = 0.043). Patients with TIA and AIS have evidence of corneal nerve loss and elevated IL6 and E-selectin levels. Larger longitudinal studies are required to determine the association between inflammatory and vascular markers and corneal nerve fiber loss in patients with cerebrovascular disease.
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Affiliation(s)
- Adnan Khan
- Department of Medicine, Research Division, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Aijaz Parray
- Department of Neurology and Institute of Neurosciences, Hamad Medical Corporation, Doha, Qatar
| | - Naveed Akhtar
- Department of Neurology and Institute of Neurosciences, Hamad Medical Corporation, Doha, Qatar
| | - Abdelali Agouni
- Department of Pharmaceutical Sciences, College of Pharmacy, QU Health, Qatar University, Doha, Qatar
| | - Saadat Kamran
- Department of Neurology and Institute of Neurosciences, Hamad Medical Corporation, Doha, Qatar
| | - Sajitha V Pananchikkal
- Department of Neurology and Institute of Neurosciences, Hamad Medical Corporation, Doha, Qatar
| | - Ruth Priyanka
- Department of Neurology and Institute of Neurosciences, Hamad Medical Corporation, Doha, Qatar
| | - Hoda Gad
- Department of Medicine, Research Division, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Georgios Ponirakis
- Department of Medicine, Research Division, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Ioannis N Petropoulos
- Department of Medicine, Research Division, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Kuan-Han Chen
- Department of Medicine, Research Division, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Kausar Tayyab
- Department of Medicine, Research Division, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Maher Saqqur
- Department of Neurology, University of Toronto Mississauga, Mississauga, ON, Canada
| | - Ashfaq Shuaib
- Stroke Program, Department of Neurology, University of Alberta, Alberta, Canada
| | - Rayaz A Malik
- Department of Medicine, Research Division, Weill Cornell Medicine-Qatar, Doha, Qatar.
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4
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Schenk MS, Wartak A, Buehler V, Zhao J, Tearney GJ, Birngruber R, Kassumeh S. Advances in Imaging of Subbasal Corneal Nerves With Micro-Optical Coherence Tomography. Transl Vis Sci Technol 2021; 10:22. [PMID: 34779835 PMCID: PMC8606792 DOI: 10.1167/tvst.10.13.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To investigate the most peripheral corneal nerve plexus using high-resolution micro-optical coherence tomography (µOCT) imaging and to assess µOCT's clinical potential as a screening tool for corneal and systemic diseases. Methods An experimental high-resolution (1.5 × 1.5 × 1 µm) µOCT setup was applied for three-dimensional imaging of the subbasal nerve plexus in nonhuman primates (NHPs) and swine within 3 hours postmortem. Morphologic features of subbasal nerves in µOCT were compared to β3 tubulin-stained fluorescence confocal microscopy (FCM). Parameters such as nerve density, nerve distribution, and imaging repeatability were evaluated, using semiautomatic image analysis in form of a custom corneal surface segmentation algorithm and NeuronJ. Results Swine and NHP corneas showed the species-specific nerve morphology in both imaging modalities. Most fibers showed a linear course, forming a highly parallel pattern, converging in a vortex with overall nerve densities varying between 9.51 and 24.24 mm/mm2. The repeatability of nerve density quantification of the µOCT scans as approximately 88% in multiple image recordings of the same cornea. Conclusions Compared to the current gold standard of FCM, µOCT's larger field of view of currently 1 × 1 mm increases the conclusiveness of density measurements, which, coupled with µOCT's feature of not requiring direct contact, shows promise for future clinical application. The nerve density quantification may be relevant for screening for systemic disease (e.g., peripheral neuropathy). Translational Relevance Technological advances in OCT technology may enable a quick assessment of corneal nerve density, which could be valuable evaluating ophthalmic and systemic peripheral innervation.
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Affiliation(s)
- Merle S Schenk
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA, USA.,Department of Ophthalmology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Andreas Wartak
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA, USA.,Department of Dermatology, Harvard Medical School, Harvard University, Boston, MA, USA
| | - Verena Buehler
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA, USA.,Institute of Biomedical Optics, University of Luebeck, Luebeck, Germany
| | - Jie Zhao
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA, USA
| | - Guillermo J Tearney
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA, USA.,Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA, USA
| | - Reginald Birngruber
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA, USA.,Institute of Biomedical Optics, University of Luebeck, Luebeck, Germany
| | - Stefan Kassumeh
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA, USA.,Department of Ophthalmology, Ludwig-Maximilians-University Munich, Munich, Germany
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Corneal nerve loss as a surrogate marker for poor pial collaterals in patients with acute ischemic stroke. Sci Rep 2021; 11:19718. [PMID: 34611233 PMCID: PMC8492683 DOI: 10.1038/s41598-021-99131-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 09/17/2021] [Indexed: 01/01/2023] Open
Abstract
In patients with acute ischemic stroke, pial collaterals play a key role in limiting neurological disability by maintaining blood flow to ischemic penumbra. We hypothesized that patient with poor pial collaterals will have greater corneal nerve and endothelial cell abnormalities. In a cross-sectional study, 35 patients with acute ischemic stroke secondary to middle cerebral artery (MCA) occlusion with poor (n = 12) and moderate-good (n = 23) pial collaterals and 35 healthy controls underwent corneal confocal microscopy and quantification of corneal nerve and endothelial cell morphology. In patients with MCA stroke, corneal nerve fibre length (CNFL) (P < 0.001), corneal nerve fibre density (CNFD) (P = 0.025) and corneal nerve branch density (CNBD) (P = 0.002) were lower compared to controls. Age, BMI, cholesterol, triglycerides, HDL, LDL, systolic blood pressure, NIHSS and endothelial cell parameters did not differ but mRS was higher (p = 0.023) and CNFL (p = 0.026) and CNBD (p = 0.044) were lower in patients with poor compared to moderate-good collaterals. CNFL and CNBD distinguished subjects with poor from moderate-good pial collaterals with an AUC of 72% (95% CI 53–92%) and 71% (95% CI 53–90%), respectively. Corneal nerve loss is greater in patients with poor compared to moderate-good pial collaterals and may act as a surrogate marker for pial collateral status in patients with ischemic stroke.
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Iqbal Z, Kalteniece A, Ferdousi M, Adam S, D'Onofrio L, Ho JH, Rao AP, Dhage S, Azmi S, Liu Y, Donn R, Malik RA, Soran H. Corneal Keratocyte Density and Corneal Nerves Are Reduced in Patients With Severe Obesity and Improve After Bariatric Surgery. Invest Ophthalmol Vis Sci 2021; 62:20. [PMID: 33475689 PMCID: PMC7817877 DOI: 10.1167/iovs.62.1.20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Purpose Obesity is associated with peripheral neuropathy, which bariatric surgery may ameliorate. The aim of this study was to assess whether corneal confocal microscopy can show a change in corneal nerve morphology and keratocyte density in subjects with severe obesity after bariatric surgery. Methods Twenty obese patients with diabetes (n = 13) and without diabetes (n = 7) underwent assessment of hemoglobin A1c (HbA1c), lipids, IL-6, highly sensitive C-reactive protein (hsCRP), and corneal confocal microscopy before and 12 months after bariatric surgery. Corneal nerve fiber density (CNFD), corneal nerve branch density (CNBD), corneal nerve fiber length (CNFL), and keratocyte density (KD) from the anterior, middle, and posterior stroma were quantified. Twenty-two controls underwent assessment at baseline only. Results CNFL (P < 0.001), CNBD (P < 0.05), and anterior (P < 0.001), middle (P < 0.001), and posterior (P < 0.001) keratocyte densities were significantly lower in obese patients compared to controls, and anterior keratocyte density (AKD) correlated with CNFL. Twelve months after bariatric surgery, there were significant improvements in body mass index (BMI; P < 0.001), HDL cholesterol (P < 0.05), hsCRP (P < 0.001), and IL-6 (P < 0.01). There were significant increases in CNFD (P < 0.05), CNBD (P < 0.05), CNFL (P < 0.05), and anterior (P < 0.05) and middle (P < 0.001) keratocyte densities. The increase in AKD correlated with a decrease in BMI (r = -0.55, P < 0.05) and triglycerides (r = -0.85, P < 0.001). There were no significant correlations between the change in keratocyte densities and corneal nerve fiber or other neuropathy measures. Conclusions Corneal confocal microscopy demonstrates early small fiber damage and reduced keratocyte density in obese patients. Bariatric surgery leads to weight reduction and improvement in lipids and inflammation and an improvement in keratocyte density and corneal nerve regeneration.
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Affiliation(s)
- Zohaib Iqbal
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.,Cardiovascular Trials Unit, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Alise Kalteniece
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.,Cardiovascular Trials Unit, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Maryam Ferdousi
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.,Cardiovascular Trials Unit, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Safwaan Adam
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Luca D'Onofrio
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Jan H Ho
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.,Cardiovascular Trials Unit, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Anoop Prasanna Rao
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Shaishav Dhage
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.,Cardiovascular Trials Unit, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Shazli Azmi
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.,Cardiovascular Trials Unit, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Yifen Liu
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Rachelle Donn
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Rayaz A Malik
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.,Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Handrean Soran
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.,Cardiovascular Trials Unit, Manchester University NHS Foundation Trust, Manchester, United Kingdom
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Petropoulos IN, Ponirakis G, Ferdousi M, Azmi S, Kalteniece A, Khan A, Gad H, Bashir B, Marshall A, Boulton AJM, Soran H, Malik RA. Corneal Confocal Microscopy: A Biomarker for Diabetic Peripheral Neuropathy. Clin Ther 2021; 43:1457-1475. [PMID: 33965237 DOI: 10.1016/j.clinthera.2021.04.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/05/2021] [Accepted: 04/08/2021] [Indexed: 02/08/2023]
Abstract
PURPOSE Diagnosing early diabetic peripheral neuropathy remains a challenge due to deficiencies in currently advocated end points. The cornea is densely innervated with small sensory fibers, which are structurally and functionally comparable to intraepidermal nerve fibers. Corneal confocal microscopy is a method for rapid, noninvasive scanning of the living cornea with high resolution and magnification. METHODS This narrative review presents the framework for the development of biomarkers and the literature on the use and adoption of corneal confocal microscopy as an objective, diagnostic biomarker in experimental and clinical studies of diabetic peripheral neuropathy. A search was performed on PubMed and Google Scholar based on the terms "corneal confocal microscopy," "diabetic neuropathy," "corneal sensitivity," and "clinical trials." FINDINGS A substantial body of evidence underpins the thesis that corneal nerve loss predicts incident neuropathy and progresses with the severity of diabetic peripheral neuropathy. Corneal confocal microscopy also identifies early corneal nerve regeneration, strongly arguing for its inclusion as a surrogate end point in clinical trials of disease-modifying therapies. IMPLICATIONS There are sufficient diagnostic and prospective validation studies to fulfill the US Food and Drug Administration criteria for a biomarker to support the inclusion of corneal confocal microscopy as a primary end point in clinical trials of disease-modifying therapies in diabetic neuropathy.
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Affiliation(s)
| | | | - Maryam Ferdousi
- Faculty of Biology, Medicine and Health, University of Manchester, Cardiovascular Trials Unit, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Shazli Azmi
- Faculty of Biology, Medicine and Health, University of Manchester, Cardiovascular Trials Unit, Manchester University NHS Foundation Trust, Manchester, United Kingdom; Centre for Diabetes, Endocrinology and Metabolism, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Alise Kalteniece
- Faculty of Biology, Medicine and Health, University of Manchester, Cardiovascular Trials Unit, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Adnan Khan
- Research Division, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Hoda Gad
- Research Division, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Bilal Bashir
- Centre for Diabetes, Endocrinology and Metabolism, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Andrew Marshall
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom; Clinical Neurophysiology, The Walton Centre, Liverpool, United Kingdom; Division of Neuroscience and Experimental Psychology, Faculty of Medical and Human Sciences, University of Manchester, Manchester, United Kingdom
| | - Andrew J M Boulton
- Faculty of Biology, Medicine and Health, University of Manchester, Cardiovascular Trials Unit, Manchester University NHS Foundation Trust, Manchester, United Kingdom; Centre for Diabetes, Endocrinology and Metabolism, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Handrean Soran
- Faculty of Biology, Medicine and Health, University of Manchester, Cardiovascular Trials Unit, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Rayaz A Malik
- Research Division, Weill Cornell Medicine-Qatar, Doha, Qatar; Faculty of Biology, Medicine and Health, University of Manchester, Cardiovascular Trials Unit, Manchester University NHS Foundation Trust, Manchester, United Kingdom.
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Gad H, Saraswathi S, Al-Jarrah B, Petropoulos IN, Ponirakis G, Khan A, Singh P, Al Khodor S, Elawad M, Almasri W, Abdelrahman H, Hussain K, Hendaus MA, Al-Mudahka F, Abouhazima K, McGrogan P, Malik RA, Akobeng AK. Corneal confocal microscopy demonstrates minimal evidence of distal neuropathy in children with celiac disease. PLoS One 2020; 15:e0238859. [PMID: 32956371 PMCID: PMC7505458 DOI: 10.1371/journal.pone.0238859] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 08/25/2020] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES The aim of this study was to utilise corneal confocal microscopy to quantify corneal nerve morphology and establish the presence of sub-clinical small fibre damage and peripheral neuropathy in children with celiac disease. METHODS This is a cross-sectional cohort study of twenty children with celiac disease and 20 healthy controls who underwent clinical and laboratory assessments and corneal confocal microscopy. Corneal nerve fiber density (no.mm2), corneal nerve branch density (no.mm2), corneal nerve fiber length (mm.mm2), corneal nerve fiber tortuosity and inferior whorl length (mm.mm2) were quantified manually. RESULTS Corneal nerve fiber density (34.7±8.6 vs. 32.9±8.6; P = 0.5), corneal nerve branch density (47.2±24.5 vs. 47.3±20.0; P = 0.1) and corneal nerve fiber length (20.0±5.1 vs. 19.5±4.5; P = 0.8) did not differ between children with celiac disease and healthy controls. Corneal nerve fiber tortuosity (11.4±1.9 vs 13.5±3.0; P = 0.01) was significantly lower and inferior whorl length (20.0±5.5 vs 23.0±3.8; P = 0.06) showed a non-significant reduction in children with celiac disease compared to healthy controls. Inferior whorl length correlated significantly with corneal nerve fiber density (P = 0.005), corneal nerve branch density (P = 0.04), and corneal nerve fiber length (P = 0.002). CONCLUSION Corneal confocal microscopy demonstrates minimal evidence of neuropathy in children with celiac disease.
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Affiliation(s)
- Hoda Gad
- Department Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Saras Saraswathi
- Division of Gastroenterology, Hepatology, and Nutrition, Sidra Medicine, Doha, Qatar
| | - Bara Al-Jarrah
- Division of Gastroenterology, Hepatology, and Nutrition, Sidra Medicine, Doha, Qatar
| | | | | | - Adnan Khan
- Department Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Parul Singh
- Research Department, Sidra Medicine, Doha, Qatar
| | | | - Mamoun Elawad
- Division of Gastroenterology, Hepatology, and Nutrition, Sidra Medicine, Doha, Qatar
| | - Wesam Almasri
- Division of Gastroenterology, Hepatology, and Nutrition, Sidra Medicine, Doha, Qatar
| | - Hatim Abdelrahman
- Division of Gastroenterology, Hepatology, and Nutrition, Sidra Medicine, Doha, Qatar
| | | | | | - Fatma Al-Mudahka
- Division of Gastroenterology, Hepatology, and Nutrition, Sidra Medicine, Doha, Qatar
| | - Khaled Abouhazima
- Division of Gastroenterology, Hepatology, and Nutrition, Sidra Medicine, Doha, Qatar
| | - Paraic McGrogan
- Division of Gastroenterology, Hepatology, and Nutrition, Sidra Medicine, Doha, Qatar
| | - Rayaz A. Malik
- Department Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
- Institute of Cardiovascular Medicine, University of Manchester, Manchester, United Kingdom
| | - Anthony K. Akobeng
- Division of Gastroenterology, Hepatology, and Nutrition, Sidra Medicine, Doha, Qatar
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Potential use of corneal confocal microscopy in the diagnosis of Parkinson's disease associated neuropathy. Transl Neurodegener 2020; 9:28. [PMID: 32611440 PMCID: PMC7330988 DOI: 10.1186/s40035-020-00204-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 06/01/2020] [Indexed: 02/07/2023] Open
Abstract
Parkinson’s disease (PD) is a chronic, progressive neurodegenerative disease affecting about 2–3% of population above the age of 65. In recent years, Parkinson’s research has mainly focused on motor and non-motor symptoms while there are limited studies on neurodegeneration which is associated with balance problems and increased incidence of falls. Corneal confocal microscopy (CCM) is a real-time, non-invasive, in vivo ophthalmic imaging technique for quantifying nerve damage in peripheral neuropathies and central neurodegenerative disorders. CCM has shown significantly lower corneal nerve fiber density (CNFD) in patients with PD compared to healthy controls. Reduced CNFD is associated with decreased intraepidermal nerve fiber density in PD. This review provides an overview of the ability of CCM to detect nerve damage associated with PD.
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10
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Khan A, Akhtar N, Kamran S, Almuhannadi H, Ponirakis G, Petropoulos IN, Babu B, Jose NR, Ibrahim RG, Gad H, Bourke P, Saqqur M, Shuaib A, Malik RA. Corneal confocal microscopy identifies greater corneal nerve damage in patients with a recurrent compared to first ischemic stroke. PLoS One 2020; 15:e0231987. [PMID: 32320450 PMCID: PMC7176137 DOI: 10.1371/journal.pone.0231987] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 04/03/2020] [Indexed: 01/01/2023] Open
Abstract
Objectives Corneal nerve damage may be a surrogate marker for the risk of ischemic stroke. This study was undertaken to determine if there is greater corneal nerve damage in patients with recurrent ischemic stroke. Methods Corneal confocal microscopy (CCM) was used to quantify corneal nerve fiber density (CNFD), corneal nerve branch density (CNBD), corneal nerve fiber length (CNFL) and corneal nerve fiber tortuosity (CNFT) in 31 patients with recurrent ischemic stroke, 165 patients with a first acute ischemic stroke and 23 healthy control subjects. Results Triglycerides (P = 0.004, P = 0.017), systolic BP (P = 0.000, P = 0.000), diastolic BP (P = 0.000, P = 0.000) and HbA1c (P = 0.000, P = 0.000) were significantly higher in patients with first and recurrent stroke compared to controls. There was no difference in age, BMI, HbA1c, total cholesterol, triglycerides, LDL, HDL, systolic and diastolic BP between patients with a first and recurrent ischemic stroke. However, CNFD was significantly lower (24.98±7.31 vs 29.07±7.58 vs 37.91±7.13, P<0.05) and CNFT was significantly higher (0.085±0.042 vs 0.064±0.037 vs 0.039±0.022, P<0.05) in patients with recurrent stroke compared to first stroke and healthy controls. CNBD (42.21±24.65 vs 50.46±27.68 vs 87.24±45.85, P<0.001) and CNFL (15.66±5.70, P<0.001 vs 17.38±5.06, P = 0.003) were equally reduced in patients with first and recurrent stroke compared to controls (22.72±5.14). Conclusions Corneal confocal microscopy identified greater corneal nerve fibre loss in patients with recurrent stroke compared to patients with first stroke, despite comparable risk factors. Longitudinal studies are required to determine the prognostic utility of corneal nerve fiber loss in identifying patients at risk of recurrent ischemic stroke.
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Affiliation(s)
- Adnan Khan
- Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Naveed Akhtar
- Department of Neurology and Institute of Neurosciences, Hamad Medical Corporation, Doha, Qatar
| | - Saadat Kamran
- Department of Neurology and Institute of Neurosciences, Hamad Medical Corporation, Doha, Qatar
| | | | | | | | - Blessy Babu
- Department of Neurology and Institute of Neurosciences, Hamad Medical Corporation, Doha, Qatar
| | - Namitha R. Jose
- Department of Neurology and Institute of Neurosciences, Hamad Medical Corporation, Doha, Qatar
| | - Rumissa G. Ibrahim
- Department of Neurology and Institute of Neurosciences, Hamad Medical Corporation, Doha, Qatar
| | - Hoda Gad
- Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Paula Bourke
- Department of Neurology and Institute of Neurosciences, Hamad Medical Corporation, Doha, Qatar
| | - Maher Saqqur
- Department of Neurology and Institute of Neurosciences, Hamad Medical Corporation, Doha, Qatar
- Department of Neurology, Stroke Program, University of Alberta, Alberta, Canada
| | - Ashfaq Shuaib
- Department of Neurology, Stroke Program, University of Alberta, Alberta, Canada
| | - Rayaz A. Malik
- Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
- * E-mail:
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11
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Salahuddin T, Qidwai U. Computational methods for automated analysis of corneal nerve images: Lessons learned from retinal fundus image analysis. Comput Biol Med 2020; 119:103666. [DOI: 10.1016/j.compbiomed.2020.103666] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 02/16/2020] [Accepted: 02/16/2020] [Indexed: 12/27/2022]
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12
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Kamran S, Khan A, Salam A, Akhtar N, Petropoulos I, Ponirakis G, Babu B, George P, Shuaib A, Malik RA. Cornea: A Window to White Matter Changes in Stroke; Corneal Confocal Microscopy a Surrogate Marker for the Presence and Severity of White Matter Hyperintensities in Ischemic Stroke. J Stroke Cerebrovasc Dis 2020; 29:104543. [PMID: 31902645 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104543] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 10/14/2019] [Accepted: 11/18/2019] [Indexed: 12/13/2022] Open
Abstract
PURPOSE The presence of white matter hyperintensities (WMH) on MRI imaging confers an increased risk of stroke, dementia, and death. Corneal confocal microscopy (CCM) can detect nerve injury non-invasively and may be a useful surrogate marker for WMH. The objective is to determine whether corneal nerve pathology identified using CCM is associated with the presence of WMH in patients with acute ischemic stroke. METHODS This is a cross-sectional study where 196 consecutive individuals with acute ischemic stroke were enrolled and underwent neurological examination, MRI brain imaging and CCM. Participants underwent blinded quantification of WMH and corneal nerve fiber density (CNFD), corneal nerve branch density (CNBD) and corneal nerve fiber length (CNFL). RESULTS The prevalence of hypertension [P = .013] was significantly higher and CNFD [P = .031] was significantly lower in patients with WMH compared to those without WMH. CNFD and CNFL were significantly lower in patients with DM without WMH [P = .008, P = .019] and in patients with DM and WMH [P = .042, P = .024] compared to patients without DM or WMH, respectively. In a multivariate model, a 1-unit decrease in the CNFD increased the risk of WMH by 6%, after adjusting for age, DM, gender, dyslipidemia, metabolic syndrome, smoking, and HbA1c. DM was associated with a decrease in all CCM parameters but was not a significant independent factor associated with WMH. CONCLUSIONS CCM demonstrates corneal nerve pathology, which is associated with the presence of WMH in participants with acute ischemic stroke. CCM may be a useful surrogate imaging marker for the presence and severity of WMHs.
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Affiliation(s)
- Saadat Kamran
- Neuroscience Institute, Hamad General Hospital, Doha, Qatar; Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar.
| | - Adnan Khan
- Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar
| | - Abdul Salam
- Neuroscience Institute, Hamad General Hospital, Doha, Qatar
| | - Naveed Akhtar
- Neuroscience Institute, Hamad General Hospital, Doha, Qatar; Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar
| | | | - Georgios Ponirakis
- Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar
| | - Blessy Babu
- Neuroscience Institute, Hamad General Hospital, Doha, Qatar
| | - Pooja George
- Neuroscience Institute, Hamad General Hospital, Doha, Qatar
| | - Ashfaq Shuaib
- Neuroscience Institute, Hamad General Hospital, Doha, Qatar
| | - Rayaz A Malik
- Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar
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13
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Gad H, Khan A, Akhtar N, Kamran S, El-Sotouhy A, Dargham SR, Petropoulos IN, Ponirakis G, Shuaib A, Streletz LJ, Malik RA. Corneal nerve and endothelial cell damage in patients with transient ischemic attack and minor ischemic stroke. PLoS One 2019; 14:e0213319. [PMID: 30875374 PMCID: PMC6420175 DOI: 10.1371/journal.pone.0213319] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 02/18/2019] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To determine if corneal confocal microscopy can identify corneal nerve and endothelial cell abnormalities and may be useful in the prognostication of patients with transient ischemic attack [1] or minor ischemic stroke (IS). METHODS Thirty-six patients admitted with TIA (n = 14) or minor IS (n = 22) underwent transcranial Doppler evaluation and corneal confocal microscopy and were compared with 18 healthy controls. RESULTS Corneal nerve fiber density (P = 0.002), branch density (P = 0.004) and fiber length (P = 0.004) were significantly lower in patients with TIA or minor IS compared to controls, with no difference between patients with TIA and minor IS. Endothelial cell density (P = 0.003) was lower and endothelial cell area (P = 0.003) and perimeter (P = 0.006) were significantly higher in patients with TIA or minor IS compared to controls, with no difference between patients with TIA and minor IS. There were no differences in corneal nerve or endothelial cell morphology between patients with and without abnormal cerebrovascular reactivity. HbA1c was independently associated with CNFL, and endothelial cell polymegathism and pleomorphism were associated with both HbA1c and total cholesterol. CONCLUSION Corneal confocal microscopy identifies corneal nerve fiber loss and endothelial cell abnormalities in patients with TIA and minor IS and independent associations with HbA1c and cholesterol.
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Affiliation(s)
- Hoda Gad
- Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Adnan Khan
- Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Naveed Akhtar
- Institute of Neurosciences, Hamad Medical Corporation, Doha, Qatar
| | - Saadat Kamran
- Institute of Neurosciences, Hamad Medical Corporation, Doha, Qatar
| | | | - Soha R. Dargham
- Biostatistics, Epidemiology & Biomathematics Research Core, Weill Cornell Medicine-Qatar, Doha, Qatar
| | | | | | - Ashfaq Shuaib
- Institute of Neurosciences, Hamad Medical Corporation, Doha, Qatar
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Leopold J. Streletz
- Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
- Institute of Neurosciences, Hamad Medical Corporation, Doha, Qatar
| | - Rayaz A. Malik
- Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
- Institute of Cardiovascular Medicine, University of Manchester, Manchester, United Kingdom
- * E-mail:
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14
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Petropoulos IN, Ponirakis G, Khan A, Gad H, Almuhannadi H, Brines M, Cerami A, Malik RA. Corneal confocal microscopy: ready for prime time. Clin Exp Optom 2019; 103:265-277. [PMID: 30834591 DOI: 10.1111/cxo.12887] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 01/28/2019] [Accepted: 01/28/2019] [Indexed: 12/13/2022] Open
Abstract
Corneal confocal microscopy is a non-invasive ophthalmic imaging modality, which was initially used for the diagnosis and management of corneal diseases. However, over the last 20 years it has come to the forefront as a rapid, non-invasive, reiterative, cost-effective imaging biomarker for neurodegeneration. The human cornea is endowed with the densest network of sensory unmyelinated axons, anywhere in the body. A robust body of evidence shows that corneal confocal microscopy is a reliable and reproducible method to quantify corneal nerve morphology. Changes in corneal nerve morphology precede or relate to clinical manifestations of peripheral and central neurodegenerative conditions. Moreover, in clinical intervention trials, corneal nerve regeneration occurs early and predicts functional gains in trials of neuroprotection. In view of these findings, it is timely to summarise the knowledge in this area of research and to explain why the case for corneal confocal microscopy is sufficiently compelling to argue for its inclusion as a Food and Drug Administration endpoint in clinical trials of peripheral and central neurodegenerative conditions.
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Affiliation(s)
| | - Georgios Ponirakis
- Division of Research, Qatar Foundation, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Adnan Khan
- Division of Research, Qatar Foundation, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Hoda Gad
- Division of Research, Qatar Foundation, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Hamad Almuhannadi
- Division of Research, Qatar Foundation, Weill Cornell Medicine-Qatar, Doha, Qatar
| | | | | | - Rayaz A Malik
- Division of Research, Qatar Foundation, Weill Cornell Medicine-Qatar, Doha, Qatar
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15
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Pagovich OE, Vo ML, Zhao ZZ, Petropoulos IN, Yuan M, Lertsuwanroj B, Ciralsky J, Lai E, Kiss S, D'Amico DJ, Mezey JG, Malik RA, Crystal RG. Corneal confocal microscopy: Neurologic disease biomarker in Friedreich ataxia. Ann Neurol 2018; 84:893-904. [PMID: 30294800 DOI: 10.1002/ana.25355] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 09/28/2018] [Accepted: 09/28/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Friedreich ataxia (FRDA), an autosomal recessive neurodegenerative disease caused by mutations in the gene encoding for the mitochondrial protein frataxin, is characterized by ataxia and gait instability, immobility, and eventual death. We evaluated corneal confocal microscopy (CCM) quantification of corneal nerve morphology as a novel, noninvasive, in vivo quantitative imaging biomarker for the severity of neurological manifestations in FRDA. METHODS Corneal nerve fiber density, branch density, and fiber length were quantified in individuals with FRDA (n = 23) and healthy age-matched controls (n = 14). All individuals underwent genetic testing and a detailed neurological assessment with the Scale for the Assessment and Rating of Ataxia (SARA) and Friedreich's Ataxia Rating Scale (FARS). A subset of individuals with FRDA who were ambulatory underwent quantitative gait assessment. RESULTS CCM demonstrated a significant reduction in nerve fiber density and length in FRDA compared to healthy controls. Importantly, CCM parameters correlated with genotype, SARA and FARS neurological scales, and linear regression modeling of CCM nerve parameter-generated equations that predict the neurologic severity of FRDA. INTERPRETATION Together, the data suggest that CCM quantification of corneal nerve morphology is a rapid, sensitive imaging biomarker for quantifying the severity of neurologic disease in individuals with FRDA. Ann Neurol 2018;84:893-904.
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Affiliation(s)
- Odelya E Pagovich
- Department of Genetic Medicine, Weill Cornell Medical College, New York, NY
| | - Mary L Vo
- Department of Neurology, Weill Cornell Medical College, New York, NY
| | - Zoe Z Zhao
- Department of Genetic Medicine, Weill Cornell Medical College, New York, NY
- Department of Biological Statistics and Computational Biology, Cornell University, Ithaca, NY
| | | | - Michelle Yuan
- Department of Genetic Medicine, Weill Cornell Medical College, New York, NY
| | | | - Jessica Ciralsky
- Department of Ophthalmology, Weill Cornell Medical College, New York, NY
| | - Edward Lai
- Department of Ophthalmology, Weill Cornell Medical College, New York, NY
| | - Szilard Kiss
- Department of Ophthalmology, Weill Cornell Medical College, New York, NY
| | - Donald J D'Amico
- Department of Ophthalmology, Weill Cornell Medical College, New York, NY
| | - Jason G Mezey
- Department of Genetic Medicine, Weill Cornell Medical College, New York, NY
- Department of Biological Statistics and Computational Biology, Cornell University, Ithaca, NY
| | - Rayaz A Malik
- Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Ronald G Crystal
- Department of Genetic Medicine, Weill Cornell Medical College, New York, NY
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16
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Khan A, Kamran S, Akhtar N, Ponirakis G, Al-Muhannadi H, Petropoulos IN, Al-Fahdawi S, Qahwaji R, Sartaj F, Babu B, Wadiwala MF, Shuaib A, Malik RA. Corneal Confocal Microscopy detects a Reduction in Corneal Endothelial Cells and Nerve Fibres in Patients with Acute Ischemic Stroke. Sci Rep 2018; 8:17333. [PMID: 30478334 PMCID: PMC6255787 DOI: 10.1038/s41598-018-35298-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 10/23/2018] [Indexed: 12/25/2022] Open
Abstract
Endothelial dysfunction and damage underlie cerebrovascular disease and ischemic stroke. We undertook corneal confocal microscopy (CCM) to quantify corneal endothelial cell and nerve morphology in 146 patients with an acute ischemic stroke and 18 age-matched healthy control participants. Corneal endothelial cell density was lower (P < 0.001) and endothelial cell area (P < 0.001) and perimeter (P < 0.001) were higher, whilst corneal nerve fibre density (P < 0.001), corneal nerve branch density (P < 0.001) and corneal nerve fibre length (P = 0.001) were lower in patients with acute ischemic stroke compared to controls. Corneal endothelial cell density, cell area and cell perimeter correlated with corneal nerve fiber density (P = 0.033, P = 0.014, P = 0.011) and length (P = 0.017, P = 0.013, P = 0.008), respectively. Multiple linear regression analysis showed a significant independent association between corneal endothelial cell density, area and perimeter with acute ischemic stroke and triglycerides. CCM is a rapid non-invasive ophthalmic imaging technique, which could be used to identify patients at risk of acute ischemic stroke.
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Affiliation(s)
- Adnan Khan
- Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Saadat Kamran
- Department of Neurology and Institute of Neurosciences, Hamad Medical Corporation, Doha, Qatar
| | - Naveed Akhtar
- Department of Neurology and Institute of Neurosciences, Hamad Medical Corporation, Doha, Qatar
| | | | | | | | - Shumoos Al-Fahdawi
- School of Electrical Engineering and Computer Science, University of Bradford, Bradford, UK
| | - Rami Qahwaji
- School of Electrical Engineering and Computer Science, University of Bradford, Bradford, UK
| | - Faheem Sartaj
- Department of Neurology and Institute of Neurosciences, Hamad Medical Corporation, Doha, Qatar
| | - Blessy Babu
- Department of Neurology and Institute of Neurosciences, Hamad Medical Corporation, Doha, Qatar
| | | | - Ashfaq Shuaib
- Department of Neurology and Institute of Neurosciences, Hamad Medical Corporation, Doha, Qatar
- Stroke Program, Department of Neurology, University of Alberta, Edmonton, Canada
| | - Rayaz A Malik
- Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar.
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17
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Bitirgen G, Turkmen K, Malik RA, Ozkagnici A, Zengin N. Corneal confocal microscopy detects corneal nerve damage and increased dendritic cells in Fabry disease. Sci Rep 2018; 8:12244. [PMID: 30116053 PMCID: PMC6095897 DOI: 10.1038/s41598-018-30688-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 08/03/2018] [Indexed: 11/30/2022] Open
Abstract
Fabry disease is characterised by neuropathic pain and accelerated vascular disease. This study evaluates the utility of corneal confocal microscopy (CCM) to non-invasively quantify corneal nerve and endothelial cell morphology and dendritic cell (DC) density in relation to disease severity in subjects with Fabry disease. Seventeen consecutive participants with Fabry disease and 17 healthy control subjects were included in this cross-sectional study. Fabry disease severity was measured using the Mainz Severity Score Index (MSSI). Central corneal sensitivity was assessed with a contact corneal esthesiometer. There was a significant reduction in the corneal sensitivity (5.75 [5.25–6.00] vs. 6.00 [6.00-6.00] cm, P = 0.014), nerve fiber density (NFD) (26.4 ± 10.1 vs. 33.7 ± 7.9 fibers/mm2, P = 0.025) and nerve fiber length (NFL) (15.9 ± 3.4 vs. 19.5 ± 4.4 mm/mm2, P = 0.012) and an increase in DC density (38.3 [17.5–97.3] vs. 13.5 [0–29.4] cells/mm2, P = 0.004) in subjects with Fabry disease compared to the healthy control subjects. The total MSSI score correlated with NFD (ρ = −0.686; P = 0.006), NFL (ρ = −0.692; P = 0.006), endothelial cell density (ρ = −0.511; P = 0.036), endothelial cell area (ρ = 0.514; P = 0.036) and α-galactosidase A enzyme activity (ρ = −0.723; P = 0.008). This study demonstrates reduced corneal sensitivity, corneal nerve fiber damage and increased DCs in subjects with Fabry disease.
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Affiliation(s)
- Gulfidan Bitirgen
- Department of Ophthalmology, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey.
| | - Kultigin Turkmen
- Division of Nephrology, Department of Internal Medicine, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
| | - Rayaz A Malik
- Weill Cornell Medicine-Qatar, Education City, Doha, Qatar.,Central Manchester University Teaching Hospitals Foundation Trust and Division of Cardiovascular Sciences, University of Manchester, Manchester, UK
| | - Ahmet Ozkagnici
- Department of Ophthalmology, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
| | - Nazmi Zengin
- Department of Ophthalmology, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
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18
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Chen X, Graham J, Petropoulos IN, Ponirakis G, Asghar O, Alam U, Marshall A, Ferdousi M, Azmi S, Efron N, Malik RA. Corneal Nerve Fractal Dimension: A Novel Corneal Nerve Metric for the Diagnosis of Diabetic Sensorimotor Polyneuropathy. Invest Ophthalmol Vis Sci 2018; 59:1113-1118. [PMID: 29490348 PMCID: PMC5830988 DOI: 10.1167/iovs.17-23342] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Objective Corneal confocal microscopy (CCM), an in vivo ophthalmic imaging modality, is a noninvasive and objective imaging biomarker for identifying small nerve fiber damage. We have evaluated the diagnostic performance of previously established CCM parameters to a novel automated measure of corneal nerve complexity called the corneal nerve fiber fractal dimension (ACNFrD). Methods A total of 176 subjects (84 controls and 92 patients with type 1 diabetes) with and without diabetic sensorimotor polyneuropathy (DSPN) underwent CCM. Fractal dimension analysis was performed on CCM images using purpose-built corneal nerve analysis software, and compared with previously established manual and automated corneal nerve fiber measurements. Results Manual and automated subbasal corneal nerve fiber density (CNFD) (P < 0.0001), length (CNFL) (P < 0.0001), branch density (CNBD) (P < 0.05), and ACNFrD (P < 0.0001) were significantly reduced in patients with DSPN compared to patients without DSPN. The areas under the receiver operating characteristic curves for identifying DSPN were comparable: 0.77 for automated CNFD, 0.74 for automated CNFL, 0.69 for automated CNBD, and 0.74 for automated ACNFrD. Conclusions ACNFrD shows comparable diagnostic efficiency to identify diabetic patients with and without DSPN.
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Affiliation(s)
- Xin Chen
- School of Computer Science, University of Nottingham, Nottingham, United Kingdom
| | - Jim Graham
- Centre for Imaging Sciences, Institute of Population Health, University of Manchester, Manchester, United Kingdom
| | | | | | - Omar Asghar
- Cardiovascular Sciences, Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - Uazman Alam
- Department of Eye and Vision Sciences, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, United Kingdom.,Diabetes and Endocrinology Research, Clinical Sciences Centre, Aintree University Hospital, Liverpool, United Kingdom
| | - Andrew Marshall
- Department of Clinical Neurophysiology, Central Manchester NHS Foundation Trust, Manchester, United Kingdom
| | - Maryam Ferdousi
- Cardiovascular Sciences, Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - Shazli Azmi
- Cardiovascular Sciences, Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - Nathan Efron
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Rayaz A Malik
- Weill Cornell Medicine-Qatar, Division of Medicine, Doha, Qatar.,Cardiovascular Sciences, Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
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19
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Petropoulos IN, Ponirakis G, Khan A, Almuhannadi H, Gad H, Malik RA. Diagnosing Diabetic Neuropathy: Something Old, Something New. Diabetes Metab J 2018; 42:255-269. [PMID: 30136449 PMCID: PMC6107364 DOI: 10.4093/dmj.2018.0056] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 05/28/2018] [Indexed: 12/13/2022] Open
Abstract
There are potentially many ways of assessing diabetic peripheral neuropathy (DPN). However, they do not fulfill U.S. Food and Drug Administration (FDA) requirements in relation to their capacity to assess therapeutic benefit in clinical trials of DPN. Over the past several decades symptoms and signs, quantitative sensory and electrodiagnostic testing have been strongly endorsed, but have consistently failed as surrogate end points in clinical trials. Therefore, there is an unmet need for reliable biomarkers to capture the onset and progression and to facilitate drug discovery in DPN. Corneal confocal microscopy (CCM) is a non-invasive ophthalmic imaging modality for in vivo evaluation of sensory C-fibers. An increasing body of evidence from multiple centers worldwide suggests that CCM fulfills the FDA criteria as a surrogate endpoint of DPN.
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Affiliation(s)
| | | | - Adnan Khan
- Division of Research, Weill Cornell Medicine Qatar, Doha, Qatar
| | | | - Hoda Gad
- Division of Research, Weill Cornell Medicine Qatar, Doha, Qatar
| | - Rayaz A Malik
- Division of Research, Weill Cornell Medicine Qatar, Doha, Qatar.
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