LAUSR

The study by Pupe et al. 1 is the fi rst paper from Brazil and indeed South America showing that corneal confocal microscopy (CCM) can identify small nerve fi ber damage and increased Langerhans cells in patients with diabetic neuropathy. Despite the inclusion of only 35 patients with diabetes and overall good glycemic control, corneal nerve loss was evident in patients with ‘ mild neuropathy ’ based on symptoms and nerve conduction, which progressively worsened with increasing severity of the diabetic neuropathy. Further-more, corneal nerve fi ber loss correlated with the severity of neuropathyassessed usingNDSand fi bular nerve conduction velocity. Our pioneering study 2 published in 2003 in Manchester, United Kingdom, also showed that CCM could be used to identify early nerve damage in subclinical diabetic neuropathy, which presented a progressive worsening in patients with moderate and severe diabetic neuropathy. A Web of Science search on June 30 th , 2022, with corneal confocal microscopy and diabetic neuropathy as the primary terms, returned 470 publications from Europe, Canada, Australia, Japan, China and now Brazil. We have recently undertaken a systematic reviewand metanalysis 3 including 38 studies and over 4,000 patients with diabetes which showed that CCM identi fi es corneal nerve fi ber loss in patients with subclinical and clinical diabetic neuropathy. We