Identification of presumed corneal neuromas and microneuromas using laser-scanning in vivo confocal microscopy: a systematic review

Authors

Holly Rose Chinnery, Department of Optometry and Vision Sciences, The University of Melbourne, Parkville, Victoria, Australia.
Rajni Rajan, Department of Optometry and Vision Sciences, The University of Melbourne, Parkville, Victoria, Australia.
Haihan Jiao, Department of Optometry and Vision Sciences, The University of Melbourne, Parkville, Victoria, Australia.
Mengliang Wu, Department of Optometry and Vision Sciences, The University of Melbourne, Parkville, Victoria, Australia.
Alexis Ceecee Zhang, Department of Optometry and Vision Sciences, The University of Melbourne, Parkville, Victoria, Australia.
Manikkuwadura Eranda De Silva, Department of Optometry and Vision Sciences, The University of Melbourne, Parkville, Victoria, Australia.
Eve Makrai, Department of Optometry and Vision Sciences, The University of Melbourne, Parkville, Victoria, Australia.
Mary Ann Stepp, School of Medicine & Health Sciences, The George Washington University, Washington, DC, USA.
Nick Di Girolamo, School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia.
Laura Elizabeth Downie, Department of Optometry and Vision Sciences, The University of Melbourne, Parkville, Victoria, Australia ldownie@unimelb.edu.au.

Document Type

Journal Article

Publication Date

6-1-2022

Journal

The British journal of ophthalmology

Volume

106

Issue

6

DOI

10.1136/bjophthalmol-2020-318156

Keywords

cornea; imaging

Abstract

BACKGROUND/AIMS: This systematic review critically evaluated peer-reviewed publications describing morphological features consistent with, or using terms related to, a 'neuroma' or 'microneuroma' in the human cornea using laser-scanning in vivo confocal microscopy (IVCM). METHODS: The review was prospectively registered on PROSPERO (CRD42020160038). Comprehensive literature searches were performed in Ovid MEDLINE, Ovid Embase and the Cochrane Library in November 2019. The review included primary research studies and reviews that described laser-scanning IVCM for examining human corneal nerves. Papers had to include at least one of a pre-specified set of keyword stems, broadly related to neuromas and microneuromas, to describe a corneal nerve feature. RESULTS: Twenty-five papers (20 original studies; 5 reviews) were eligible. Three original studies evaluated corneal nerve features in healthy eyes. Most papers assessed corneal nerves in ocular and systemic conditions; seven studies did not include a control/comparator group. There was overlap in terminology used to describe nerve features in healthy and diseased corneas (eg, bulb-like/bulbous, penetration, end/s/ing). Inspection of IVCM images within the papers revealed that features termed 'neuromas' and 'microneuromas' could potentially be physiological corneal stromal-epithelial nerve penetration sites. We identified inconsistent definitions for terms, and limitations in IVCM image acquisition, sampling and/or reporting that may introduce bias and lead to inaccurate representation of physiological nerve characteristics as pathological. CONCLUSION: These findings identify a need for consistent nomenclature and definitions, and rigorous IVCM scanning and analysis protocols to clarify the prevalence of physiological, as opposed to pathological, corneal nerve features.

APA Citation

Chinnery, Holly Rose; Rajan, Rajni; Jiao, Haihan; Wu, Mengliang; Zhang, Alexis Ceecee; De Silva, Manikkuwadura Eranda; Makrai, Eve; Stepp, Mary Ann; Di Girolamo, Nick; and Downie, Laura Elizabeth, "Identification of presumed corneal neuromas and microneuromas using laser-scanning in vivo confocal microscopy: a systematic review" (2022). GW Authored Works. Paper 1174.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/1174

Department

Anatomy and Regenerative Biology