Corneal confocal microscopy deemed useful in immune-mediated neuropathies


Corneal confocal microscopy was effective at identifying and diagnosing subsets of chronic inflammatory demyelinating polyradiculoneuropathy and multifocal motor neuropathy, according to Dr. Mark Stettner and his associates.

The investigators used corneal confocal microscopy (CCM) to show that measurements of corneal nerve fiber properties including overall density, branch density, and length, were reduced and immune cell infiltration was increased in 88 patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and 6 with multifocal motor neuropathy (MMN), compared with 88 healthy controls.

The number of dendritic cells with corneal nerve fiber contacts rose significantly along with the duration of disease, starting with comparisons of durations of less than 1 year versus greater than 1 year. Patients without motor disability had significantly lower values for corneal nerve fiber length and density than did those with slight motor disability, but this did not correlate with the degree of severity and was limited to the lower extremities. Corneal nerve fiber density and length were further reduced and nondendritic cells were increased in patients with painful neuropathy, compared with painless neuropathy. CIDP patients with antineuronal antibodies also had increased nondendritic cells, but the number of cells in proximity to corneal nerve fibers did not differ according to antibody status, the investigators found.

“While the characterization of cells into dendritic and nondendritic cells based on the morphological criteria should be interpreted with caution, it may provide insights into the underlying pathophysiology. CCM may be a useful technique in the diagnosis and management of patients with inflammatory neuropathy and this warrants further studies,” the investigators concluded.

Find the full study in Annals of Clinical and Translational Neurology (doi: 10.1002/acn3.275).


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