Corneal confocal microscopy as a non-invasive test to assess diabetic peripheral neuropathy.

OBJECTIVE: To evaluate the efficacy of corneal confocal microscopy (CCM) as a non-invasive test to assess diabetic peripheral neuropathy in Chinese patients diagnosed with type 2 diabetes. RESEARCH DESIGN AND METHODS: Diabetic distal symmetric polyneuropathy (DSPN) and its severity degrees were assessed based on the modified Toronto diagnostic criteria in 128 patients with type 2 diabetes (No DSPN [n = 49], mild DSPN [n = 43], moderate-to-severe DSPN [n = 36]) and 24 age-matched controls. CCM was also examined in all enrolled subjects. Corneal nerve fiber length (CNFL), corneal nerve branch density (CNBD) and corneal nerve fiber density (CNFD) were analyzed by Fiji imaging analysis software. The efficacy of CCM as a non-invasive test to assess diabetic peripheral neuropathy was determined. RESULTS: CNFL was 17.99 ±â€¯0.66, 15.82 ±â€¯0.64, 14.98 ±â€¯0.63, and 12.49 ±â€¯0.93 in healthy controls, T2DM patients with no, mild, and moderate-to-severe DPN, respectively. CNFL in type 2 diabetes patients with no, mild, and moderate-to-severe DSPN demonstrated a significant reduction than in healthy controls (P = .012, .003 and <.001, respectively). CNFL in patients with moderate-to-severe DSPN was significantly shorter than in patients with no or mild DSPN (P < .001 and .004, respectively). CNBD was 41.48 ±â€¯3.35, 33.02 ±â€¯2.50, 30.91 ±â€¯2.33, and 18.00 ±â€¯2.33 in healthy controls, T2DM patients with no, mild, and moderate-to-severe DPN, respectively. CNBD in healthy control was significantly higher than in type 2 diabetes patients with no, mild, and moderate-to-severe DSPN (P = .036, 0.016 and < .001, respectively). CNBD in patients with moderate-to-severe DSPN was significantly lower than in patients with no or mild DSPN (P < .001 for both). CNFD was 35.32 ±â€¯1.18, 35.68 ±â€¯1.10, 34.54 ±â€¯1.12, and 32.28 ±â€¯1.76 in healthy controls, T2DM patients with no, mild, and moderate-to-severe DPN, respectively. CNFD did not differ among the four groups. In an analysis that divided CNFL, CNFD and CNBD into quartiles, there were no significant differences in electromyography findings and vibration perception threshold among the 4 groups; however, significant differences were seen in the positive distribution of temperature perception measurements following CNFL and CNBD stratification (P = .001 and < .001, respectively). CONCLUSION: CCM might be a non-invasive method for detecting DSPN and its severity degree in Chinese patients diagnosed with type 2 diabetes.

Unrecognized and unregistered blindness in people 70 or older in Jing'an district, Shanghai, China.

AIM: To evaluate the efficacy of a registration system for the blind people and to monitor the blindness due to uncorrected refractive error and cataract in Jing'an district, Shanghai, China. METHODS: Five hundred and ten blind people, based on visual acuity screening in a population aged 70 or older were enrolled into the study. Four hundred and forty subjects were interviewed. The following data were collected on each patient: demographic data, number of hospital visits for eye related problems, distance visual acuity, visual fields, ophthalmic diagnoses, education and registration status. If the eligible subject was not registered as blind, the reason for non-registration was recorded. RESULTS: Ten point nine one percent blindness was due to cataract, 27.5% due to uncorrected refractive error, and only 61.59% met the eligible blindness criteria (uncorrected refractive error and cataract are not considered as eligible blindness). The first four leading causes of eligible blindness were age related macular degeneration (25.09%), myopic macular degeneration (21.40%), glaucoma (18.82%) and corneal disease (8.12%). Only 68.27% eligible blind people were registered. The patients with macular degeneration and glaucoma tended not to register. Blind people with an above primary school education were 2.59 times more likely to be registered than those who were illiterate or had only a primary school education (OR=2.59, 95%CI: 1.49-4.48, P<0.01). Patients who had 4 or more visits to the hospital requesting eye care services in a year were 2.2 times more likely to be registered than those with less than 4 visits to the hospital (OR=2.54, 95%CI: 1.47-4.38, P<0.001). The first two leading reasons of misregistration were unknowing the registration system (48%) and unwilling to register (21%). CONCLUSION: Under-registration of the eligible blind people exists in the registry system. Education and the number of hospital visits for eye care services were factors associated with registration levels. Uncorrected refractive error and cataract are important causes of blindness.

[The clinical study of the epithelial flap of painless LASEK and Epi-LASIK].

OBJECTIVE: To protect epithelial flap and improve the rate of painless LASEK and Epi-LASIK surgery. METHODS: 285 eyes of 285 cases of LASEK, 39 eyes of 39 cases of Epi-LASIK were involved in the study. Laser machines used in the study included Mel 80, lasersight LSX, NIDEK EC5000, VISX 4star, AOV (66 vision) and 217Z. The Epi-LASIK hinge position was routinely at 11-12 o'clock. The application time of alcohol for LASEK was 10-20 seconds. The hinge was routinely at 12-1 o'clock by the way of epithelial-CCC. RESULTS: Postoperative pain: 269 cases (91.23%) in LASEK and 36 cases (92.31%) in Epi-LASIK were quiet (patients did not complain pain and open the eyes in a nature way), There was no significant difference in the ration of postoperative pain between two groups. LASEK: CLs were taken off in 10 cases (3.51%) in 7-11 days. Epi-LASIK: CLs were taken off in 2 cases (5.13%) in 7-10 days. The main reason of delayed taking of the CLs was irregular edema of epithelium. CONCLUSIONS: The LASEK and Epi-LASIK are able to be a painless procedure. LASEK/Epi-LASIK can get quiet situation postoperatively with quickly recovery of effective vision by LASIK. Delayed taking off CLs is safe and effective to protect the survival epithelium in case of the epithelial flap delayed healing.