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The article discusses the use of corneal confocal microscopy (CCM) in diagnosing non-length-dependent small fiber neuropathy (SFN). The study found that CCM was less sensitive than skin biopsy in detecting small nerve fiber damage in patients with painful chronic idiopathic axonal polyneuropathy (CIAP). However, CCM may be more informative in cases of SFN with a non-length-dependent distribution. The article also mentions that CCM has shown promise in diagnosing painful diabetic neuropathy, which can have a heterogeneous presentation. Further research is needed to determine the diagnostic efficiency of CCM in different conditions. [Extracted from the article]

The clinical spectrum of small fiber neuropathy (SFN) encompasses manifestations related to the involvement of thinly myelinated A‐delta and unmyelinated C fibers, including not only the classical distal phenotype, but also a non–length‐dependent (NLD) presentation that can be patchy, asymmetrical, upper limb‐predominant, or diffuse. This narrative review is focused on NLD‐SFN. The diagnosis of NLD‐SFN can be problematic, due to its varied and often atypical presentation, and diagnostic criteria developed for distal SFN are not suitable for NLD‐SFN. The topographic pattern of NLD‐SFN is likely related to ganglionopathy restricted to the small neurons of dorsal root ganglia. It is often associated with systemic diseases, but about half the time is idiopathic. In comparison with distal SFN, immune‐mediated diseases are more common than dysmetabolic conditions. Treatment is usually based on the management of neuropathic pain. Disease‐modifying therapy, including immunotherapy, may be effective in patients with identified causes. Future research on NLD‐SFN is expected to further clarify the interconnected aspects of phenotypic characterization, diagnostic criteria, and pathophysiology. [ABSTRACT FROM AUTHOR]