Abstract： Objective: To observe changes of corneal subbasal nerve plexus and langerhans cells in diabetic retinopathy patients after panretinal photocoagulation (PRP) based on the wide-field mosaic, analyze the their correlation. Methods: In this prospective clinical study, type 2 diabetic patients with binocular diabetic retinopathy stage Ⅳ and waited for PRP treatment in Shanxi Eye Hospital from April to November in 2019 were included. Their severe eyes were chosen as the treatment eye and the contralateral eyes were chosen as the control eye. Corneal confocal microscopy (CCM) was performed before PRP treatment, 1 week after every photocoagulation for 4 times, and 1 month after the completion of PRP to examine the changes of SNP and Langerhans cell (LC) over an area of 2-3 mm around the whorl-like complex, and measure the of NFL value and LC density. The NFL value and LC density among each observation time point were compared by repeated measurement ANOVA, and the correlation between repeated measurement of NFL value and LC density before and after PRP treatment was analyze by MIXED model of SAS software. Results: A total of 49 patients were included. After PRP treatment, SNP nerve fibers showed decrease in diameter, accompanied by different degrees of nerve architecture loss in the whorl-like region in the treatment eye of some patients; the overall comparison of NFL values among observation time points was statistically significant (F=8.039, P=0.004), among which the NFL value differences between pre-PRP treatment [(15.5±3.7)mm/mm2 ] and 1 week after the second photocoagulation [(15.0±3.5)mm/mm2 ], 1 week after the third photocoagulation [(13.4±4.3)mm/mm2 ], and 1 week after the fourth photocoagulation [(13.5±4.1)mm/mm2 ] were statistically significant (all P<0.05). Meanwhile, LC was increased, clustering around the whorl-like area; the mature LC infiltration area also were accompanied nerve architecture loss. The overall difference in LC density among observation time points was statistically significant (F=12.350, P<0.001), among which the LC density differences between pre-PRP treatment [(40±54)cells/mm2 ] and 1 week after the third photocoagulation [(79±91)cells/mm2 ], 1 week after the forth photocoagulation [(98±126)cells/mm2 ] and 1 month after PRP [(87±102)cells/mm2 ] was statistically significant (all P<0.05); Correlation analysis showed that the LC density 1 week after the fourth photocoagulation were significantly positively correlated with their corresponding baseline levels in the treatment eye (r=0.674, P<0.001), and there was a negative correlation between repeated measurement of NFL value and LC density (P-=-0.041). Conclusions: Multiple photocoagulation of PRP treatment can lead to the increase of LC density; mature LC can lead to the damage of SNP nerve architecture.
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