Corneal confocal microscopy detects early nerve regeneration in diabetic neuropathy after simultaneous pancreas and kidney transplantation

Mitra Tavakoli, Maria Mitu-Pretorian, Ioannis N. Petropoulos, Hassan Fadavi, Omar Asghar, Uazman Alam, Georgios Ponirakis, Maria Jeziorska, Andy Marshall, Nathan Efron, Andrew J. Boulton, Titus Augustine, Rayaz A. Malik

Research output: Contribution to journalArticle

142 Citations (Scopus)


Diabetic neuropathy is associated with increased morbidity and mortality. To date, limited data in subjects with impaired glucose tolerance and diabetes demonstrate nerve fiber repair after intervention. This may reflect a lack of efficacy of the interventions but may also reflect difficulty of the tests currently deployed to adequately assess nerve fiber repair, particularly in short-term studies. Corneal confocal microscopy (CCM) represents a novel noninvasive means to quantify nerve fiber damage and repair. Fifteen type 1 diabetic patients undergoing simultaneous pancreas-kidney transplantation (SPK) underwent detailed assessment of neurologic deficits, quantitative sensory testing (QST), electrophysiology, skin biopsy, corneal sensitivity, and CCM at baseline and at 6 and 12 months after successful SPK. At baseline, diabetic patients had a significant neuropathy compared with control subjects. After successful SPK there was no significant change in neurologic impairment, neurophysiology, QST, corneal sensitivity, and intraepidermal nerve fiber density (IENFD). However, CCM demonstrated significant improvements in corneal nerve fiber density, branch density, and length at 12 months. Normalization of glycemia after SPK shows no significant improvement in neuropathy assessed by the neurologic deficits, QST, electrophysiology, and IENFD. However, CCM shows a significant improvement in nerve morphology, providing a novel noninvasive means to establish early nerve repair that is missed by currently advocated assessment techniques.

Original languageEnglish
Pages (from-to)254-260
Number of pages7
Issue number1
Publication statusPublished - 1 Jan 2013


ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism

Cite this

Tavakoli, M., Mitu-Pretorian, M., Petropoulos, I. N., Fadavi, H., Asghar, O., Alam, U., Ponirakis, G., Jeziorska, M., Marshall, A., Efron, N., Boulton, A. J., Augustine, T., & Malik, R. A. (2013). Corneal confocal microscopy detects early nerve regeneration in diabetic neuropathy after simultaneous pancreas and kidney transplantation. Diabetes, 62(1), 254-260.