Karsten Winter1,2, Patrick Scheibe1, Bernd Köhler3, Stephan Allgeier4, Rudolf F Guthoff2, Oliver Stachs2. 1. a Translational Centre for Regenerative Medicine, University of Leipzig , Leipzig , Germany . 2. b Department of Ophthalmology , University of Rostock , Rostock , Germany . 3. c Institute for Applied Computer Science, Karlsruhe Institute of Technology (KIT) , Karlsruhe , Germany , and. 4. d Institute for Applied Computer Science/Automation, Karlsruhe Institute of Technology (KIT) , Karlsruhe , Germany.
Abstract
PURPOSE: The corneal subbasal nerve plexus (SNP) offers high potential for early diagnosis of diabetic peripheral neuropathy. Changes in subbasal nerve fibers can be assessed in vivo by confocal laser scanning microscopy (CLSM) and quantified using specific parameters. While current study results agree regarding parameter tendency, there are considerable differences in terms of absolute values. The present study set out to identify factors that might account for this high parameter variability. MATERIALS AND METHODS: In three healthy subjects, we used a novel method of software-based large-scale reconstruction that provided SNP images of the central cornea, decomposed the image areas into all possible image sections corresponding to the size of a single conventional CLSM image (0.16 mm2), and calculated a set of parameters for each image section. In order to carry out a large number of virtual examinations within the reconstructed image areas, an extensive simulation procedure (10,000 runs per image) was implemented. RESULTS: The three analyzed images ranged in size from 3.75 mm2 to 4.27 mm2. The spatial configuration of the subbasal nerve fiber networks varied greatly across the cornea and thus caused heavily location-dependent results as well as wide value ranges for the parameters assessed. Distributions of SNP parameter values varied greatly between the three images and showed significant differences between all images for every parameter calculated (p < 0.001 in each case). CONCLUSIONS: The relatively small size of the conventionally evaluated SNP area is a contributory factor in high SNP parameter variability. Averaging of parameter values based on multiple CLSM frames does not necessarily result in good approximations of the respective reference values of the whole image area. This illustrates the potential for examiner bias when selecting SNP images in the central corneal area.
PURPOSE: The corneal subbasal nerve plexus (SNP) offers high potential for early diagnosis of diabetic peripheral neuropathy. Changes in subbasal nerve fibers can be assessed in vivo by confocal laser scanning microscopy (CLSM) and quantified using specific parameters. While current study results agree regarding parameter tendency, there are considerable differences in terms of absolute values. The present study set out to identify factors that might account for this high parameter variability. MATERIALS AND METHODS: In three healthy subjects, we used a novel method of software-based large-scale reconstruction that provided SNP images of the central cornea, decomposed the image areas into all possible image sections corresponding to the size of a single conventional CLSM image (0.16 mm2), and calculated a set of parameters for each image section. In order to carry out a large number of virtual examinations within the reconstructed image areas, an extensive simulation procedure (10,000 runs per image) was implemented. RESULTS: The three analyzed images ranged in size from 3.75 mm2 to 4.27 mm2. The spatial configuration of the subbasal nerve fiber networks varied greatly across the cornea and thus caused heavily location-dependent results as well as wide value ranges for the parameters assessed. Distributions of SNP parameter values varied greatly between the three images and showed significant differences between all images for every parameter calculated (p < 0.001 in each case). CONCLUSIONS: The relatively small size of the conventionally evaluated SNP area is a contributory factor in high SNP parameter variability. Averaging of parameter values based on multiple CLSM frames does not necessarily result in good approximations of the respective reference values of the whole image area. This illustrates the potential for examiner bias when selecting SNP images in the central corneal area.
Authors: B Köhler; S Allgeier; A Bartschat; R F Guthoff; S Bohn; K-M Reichert; O Stachs; K Winter; R Mikut Journal: Ophthalmologe Date: 2017-07 Impact factor: 1.059
Authors: B S Kowtharapu; K Winter; C Marfurt; S Allgeier; B Köhler; M Hovakimyan; T Stahnke; A Wree; O Stachs; R F Guthoff Journal: Eye (Lond) Date: 2016-11-04 Impact factor: 3.775
Authors: Aleksandra Matuszewska-Iwanicka; Bernd Stratmann; Oliver Stachs; Stephan Allgeier; Andreas Bartschat; Karsten Winter; Rudolf Guthoff; Diethelm Tschoepe; Hans-Joachim Hettlich Journal: Ophthalmol Ther Date: 2022-10-03
Authors: Dan Ziegler; Karsten Winter; Alexander Strom; Andrey Zhivov; Stephan Allgeier; Nikolaos Papanas; Iris Ziegler; Jutta Brüggemann; Bernd Ringel; Sabine Peschel; Bernd Köhler; Oliver Stachs; Rudolf F Guthoff; Michael Roden Journal: PLoS One Date: 2017-03-15 Impact factor: 3.240