Cornea is the most innervated organ of human body,which is responsible for the maintenance of corneal nutri-tion and homeostasis.Corneal innervation is impaired in diabetes,and it has been widely proved that diabetic neuropathy affects the corneal sub-basal nerve plexus,including corneal nerve fibers morphology,length and density.These changes seem to prior to the clinical onset of diabetic neuropathy.Corneal confocal microscopy(CCM)is a rapid,non-invasive,reproducible,and simple ophthalmic imaging technique that allows for the study of different layers of the cornea at a cel-lular level.It enables the in vivo assessment of corneal nerve loss in patients with diabetes.Corneal nerve loss has dem-onstrated excellent diagnostic value for somatic and autonomic diabetic neuropathy and can be used to monitor its progres-sion.Recently,an increasing number of studies have utilized corneal confocal microscopy to detect diabetic neuropathy.This review summarized the corneal nerve alterations in patients with diabetes and the relationship between the extent of these changes and the duration and severity of diabetes.It also provided an overview of the relevant evidence regarding the utility of CCM in the early evaluation and monitoring of diabetic peripheral sensorimotor polyneuropathy.We believe that the information about the corneal nerve fibers obtained from the in vivo investigation of the sub-basal nerve plexus u-sing CCM is crucial for the early detection and monitoring of diabetic peripheral neuropathy and its progression.
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