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World J Diabetes. Sep 15, 2016; 7(17): 406-411
Published online Sep 15, 2016. doi: 10.4239/wjd.v7.i17.406
In vivo corneal confocal microscopy in diabetes: Where we are and where we can get
Ernesto Maddaloni, Francesco Sabatino
Ernesto Maddaloni, Unit of Endocrinology and Diabetes, Department of Medicine, University Campus Bio-Medico, 00128 Rome, Italy
Francesco Sabatino, Department of Ophthalmology, University Campus Bio-Medico, 00128 Rome, Italy
Author contributions: Maddaloni E and Sabatino F reviewed the literature and wrote the paper.
Conflict-of-interest statement: The Authors declare no conflict of interest related to this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Ernesto Maddaloni, MD, Unit of Endocrinology and Diabetes, Department of Medicine, University Campus Bio-Medico, Via Alvaro del Portillo 21, 00128 Rome, Italy. e.maddaloni@unicampus.it
Telephone: +39-06-22541697 Fax: +39-06-22541698
Received: March 5, 2016
Peer-review started: March 7, 2016
First decision: June 16, 2016
Revised: June 24, 2016
Accepted: July 14, 2016
Article in press: July 18, 2016
Published online: September 15, 2016
Processing time: 188 Days and 23.8 Hours
Abstract

In vivo corneal confocal microscopy (IVCCM) is a novel, reproducible, easy and noninvasive technique that allows the study of the different layers of the cornea at a cellular level. As cornea is the most innervated organ of human body, several studies investigated the use of corneal confocal microscopy to detect diabetic neuropathies, which are invalidating and deadly complications of diabetes mellitus. Corneal nerve innervation has been shown impaired in subjects with diabetes and a close association between damages of peripheral nerves due to the diabetes and alterations in corneal sub-basal nerve plexus detected by IVCCM has been widely demonstrated. Interestingly, these alterations seem to precede the clinical onset of diabetic neuropathies, paving the path for prevention studies. However, some concerns still prevent the full implementation of this technique in clinical practice. In this review we summarize the most recent and relevant evidences about the use of IVCCM for the diagnosis of peripheral sensorimotor polyneuropathy and of autonomic neuropathy in diabetes. New perspectives and current limitations are also discussed.

Keywords: Corneal confocal microscopy; Neuropathy; diabetes; Cornea; New technologies

Core tip: Diabetic neuropathies are common, invalidating and often undiagnosed complications affecting a huge number of subjects with diabetes. In vivo corneal confocal microscopy is a novel, reproducible, easy and noninvasive technique that has been widely studied as a useful tool for the diagnosis of neuropathy. Promising data suggest its implementation in clinical and research practice will help to face the current health emergency related to nerve damages in diabetes.