Cahill M, Eustace P, de Jesus V
The Institute of Ophthalmology, University College Dublin, Mater Misericordiae Hospital, 60 Eccles Street, Dublin 7, Ireland.
Br J Ophthalmol. 2001 Oct;85(10):1225-30. doi: 10.1136/bjo.85.10.1225.
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.
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.
In total, 72 type I and 69 type II diabetic patients were compared with 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 particularly when this was assessed with the Valsalva ratio.
Denervation hypersensitivity to dilute pilocarpine is a result of 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 dysfunction occurs before cardiovascular autonomic changes and detection of pupil denervation hypersensitivity to dilute pilocarpine is an inexpensive way to detect early DAN.
背景/目的：将无糖尿病自主神经病变（DAN）临床证据的I型和II型糖尿病患者的自主瞳孔变化与年龄匹配的对照组进行比较。评估糖尿病患者瞳孔与心血管自主功能之间的关系。
进行一项病例对照研究，根据糖尿病类型和病程对糖尿病患者进行分组。使用静态红外瞳孔测量法比较糖尿病组和对照组在暗适应状态下的平均瞳孔大小，以及使用0.1%毛果芸香碱和4%可卡因后瞳孔大小的平均变化百分比。所有糖尿病患者均使用瓦尔萨尔瓦比率、30:15比率和直立性低血压测试进行心血管自主功能评估。
总共将72例I型和69例II型糖尿病患者与120例对照组进行比较。糖尿病组的平均暗适应瞳孔大小明显小于对照组。除病程小于5年的I型糖尿病患者外，所有患者组对稀释毛果芸香碱的瞳孔平均收缩百分比均明显高于对照组。糖尿病患者和对照组对4%可卡因的平均瞳孔扩张百分比无显著差异。很大一部分患者的心血管自主功能正常，尤其是在用瓦尔萨尔瓦比率评估时。
对稀释毛果芸香碱的去神经超敏反应是糖尿病患者瞳孔副交感神经供应受损的结果。这发生在瞳孔交感神经通路受影响之前，可在疾病早期检测到，这可能是糖尿病患者瞳孔较小的一个可能解释。瞳孔自主神经功能障碍发生在心血管自主神经变化之前，检测对稀释毛果芸香碱的瞳孔去神经超敏反应是检测早期DAN的一种廉价方法。
