Zusammenfassung
Schätzungsweise 50 % der Patienten mit Diabetes mellitus leiden an einer Polyneuropathie, die häufig zu spät erkannt wird. Daher stellt sich die Frage, ob Bildgebungsverfahren am Auge wie die optische Kohärenztomographie der Retina und die konfokale Mikroskopie der Kornea zur Diagnostik und Verlaufskontrolle von neurodegenerativen Veränderungen bei Patienten mit Diabetes mellitus geeignet sind. Dies konnte durch De Clerck et al. mittels einer systematischen Zusammenfassung von Studien bestätigt werden: 11 davon wurden hinsichtlich der kornealen Konfokalmikroskopie weiter ausgewertet. Nach etwa 15 Jahren eines zumeist im juvenilen Alter manifestierten Typ-1-Diabetes mellitus waren die korneale Nervenfaserlänge und -dichte bereits reduziert, obwohl noch keine klinisch manifeste Neuropathie vorlag. Eine Untersuchung zu diesem Zeitpunkt erscheint sinnvoll. Der Typ-2-Diabetes mellitus im höheren Lebensalter ist zumeist mit einem metabolischen Syndrom vergesellschaftet und der Manifestationszeitpunkt der Erkrankung unbekannt. Bereits bei Diagnosestellung eines Typ-2-Diabetes mellitus sollte daher eine korneale Konfokalmikroskopie durchgeführt werden. Patienten mit längerer Krankheitsdauer und deutlichen Veränderungen des kornealen Nervenplexus zeigten bereits klinische Symptome einer Polyneuropathie und litten häufig an einer proliferativen Retinopathie. Die Zugänglichkeit des Auges mittels nichtinvasiver optischer Verfahren sollte im Rahmen der Behandlung von Patienten mit Diabetes mellitus verstärkt genutzt werden, um Risikopatienten frühzeitig zu identifizieren. Weiterführende Longitudinalstudien sind von hoher Notwendigkeit.
Abstract
It is estimated that approximately 50% of patients with diabetes mellitus suffer from polyneuropathy, which is frequently diagnosed too late. Consequently, the question arises whether imaging procedures of the eye, namely optical coherence tomography of the retina and confocal microscopy of the cornea are suitable for the diagnostics and follow-up control of neurodegenerative changes in patients with diabetes mellitus. De Clerck and co-workers could demonstrate this by a systematic review of studies. Of these studies 11 were further evaluated with respect to corneal confocal microscopy. Approximately 15 years after juvenile type 1 diabetes a reduction of corneal nerve fiber length and density was observed, although clinical signs of neuropathy were absent. At this stage an examination seems reasonable. Type 2 diabetes mellitus in the elderly is often associated with a metabolic syndrome and its time of manifestation remains unknown; therefore, corneal confocal microscopy should be implemented at the time of diagnosis of type 2 diabetes. Patients with long disease duration and significant changes in the corneal nerve plexus already showed clinical signs of polyneuropathy and often suffered from proliferative retinopathy. The accessibility of the eye for non-invasive optical modalities should be used more often in the treatment of patients with diabetes mellitus for early identification of patients at risk. Further longitudinal studies are highly necessary.
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Baltrusch, S. Konfokal mikroskopisch sichtbarer kornealer Nervenplexus als Biomarker für systemische Erkrankungen. Ophthalmologe 114, 592–600 (2017). https://doi.org/10.1007/s00347-017-0480-4
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DOI: https://doi.org/10.1007/s00347-017-0480-4