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Titolo:
Pupillary autonomic denervation with increasing duration of diabetes mellitus
Autore:
Cahill, M; Eustace, P; de Jesus, V;
Indirizzi:
Univ Coll Dublin, Mater Misericordiae Hosp, Inst Ophthalmol, Dublin 7, Ireland Univ Coll Dublin Dublin Ireland 7 sp, Inst Ophthalmol, Dublin 7, Ireland
Titolo Testata:
BRITISH JOURNAL OF OPHTHALMOLOGY
fascicolo: 10, volume: 85, anno: 2001,
pagine: 1225 - 1230
SICI:
0007-1161(200110)85:10<1225:PADWID>2.0.ZU;2-5
Fonte:
ISI
Lingua:
ENG
Soggetto:
LIGHT REFLEX; NEUROPATHY; SIZE; PARAMETERS;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
30
Recensione:
Indirizzi per estratti:
Indirizzo: Cahill, M Duke Univ, Ctr Eye, POB 3802,Erwin Rd, Durham, NC 27710 USA DukeUniv POB 3802,Erwin Rd Durham NC USA 27710 am, NC 27710 USA
Citazione:
M. Cahill et al., "Pupillary autonomic denervation with increasing duration of diabetes mellitus", BR J OPHTH, 85(10), 2001, pp. 1225-1230

Abstract

Background/aims-The autonomic pupillary changes in type I and II diabetic patients without clinical evidence of diabetic autonomic neuropathy (DAN) were compared with age matched controls. The relation between pupillary and cardiovascular autonomic function was assessed in the diabetic patients. Methods-A case-control study was performed with diabetics grouped according to type and duration of diabetes. Static infrared pupillography was used to compare mean dark adapted pupil size and mean percentage changes in pupil size with pilocarpine 0.1% and cocaine 4% in the diabetic and control groups. All diabetic patients underwent cardiovascular autonomic function assessment using the Valsalva ratio, the 30:15 ratio, and testing for orthostatic hypotension. Results-In total, 72 type I and 69 type II diabetic patients were comparedwith 120 controls. Mean dark adapted pupil size was significantly smaller in diabetic groups than controls. Except for type I diabetics with disease for less than 5 years, all patient groups had significantly greater mean percentage constriction in pupil size in response to dilute pilocarpine than controls. There was no significant difference between the mean percentage dilatation in response to cocaine 4% in diabetics and controls. A high proportion of patients had normal cardiovascular autonomic function particularlywhen this was assessed with the Valsalva ratio. Conclusions-Denervation hypersensitivity to dilute pilocarpine is a resultof damage to the pupillary parasympathetic supply of diabetic patients. This occurs before the pupillary sympathetic pathway is affected, it can be detected early in the disease, and it may be a possible explanation for the small pupil size seen in diabetic patients. Pupillary autonomic dysfunctionoccurs before cardiovascular autonomic changes and detection of pupil denervation hypersensitivity to dilute pilocarpine is an inexpensive way to detect early DAN.

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Documento generato il 31/03/20 alle ore 19:15:25