Trigler Lucas, Siatkowski R Michael, Oster Angela S, Feuer William J, Betts Chad L, Glaser Joel S, Schatz Norman J, Farris Bradley K, Flynn Harry W
Dean A McGee Eye Institute, Department of Ophthalmology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73104, USA.
Ophthalmology. 2003 Aug;110(8):1545-50. doi: 10.1016/S0161-6420(03)00542-6.
To review the clinical characteristics, prevalence, and severity of retinopathy in diabetics with cranial nerve (CN) 3, 4, and/or 6 palsies, and to determine the relationship between type and duration of diabetes mellitus (DM), presence of retinopathy, and occurrence of CN palsy.
Retrospective, comparative cohort study.
Chart reviews of 2229 patients with CN 3, 4, and/or 6 palsies were performed at the Bascom Palmer Eye Institute (BPEI) from January 1991 through December 1997 and at the Dean A. McGee Eye Institute (DMEI) from January 1994 through July 2001. A total of 306 patients qualified for the study group. The Wisconsin Epidemiologic Study of Diabetic Retinopathy (WESDR) was used as a control.
Demographic and clinical data were extracted to determine characteristics of patients with diabetic ophthalmoplegia. The subsets of data regarding type of DM and level of diabetic retinopathy in the study population were compared with the WESDR control data for statistical analysis.
The prevalence of diabetic retinopathy in patients with diabetic ophthalmoplegia.
Of 2229 patients at both institutions with ocular motor CN palsy, 306 (13.7%) were associated with DM. The frequency of CN involvement was 6 (50.0%), 3 (43.3%), and 4 (6.7%). There was a total of 12 patients (3.9%) with consecutive palsies and 8 patients (2.6%) with simultaneous palsies (5 unilateral and 3 bilateral). At both institutions, the prevalence of retinopathy controlling for duration of DM was lower in both insulin-dependent DM (IDDM) and non-IDDM (NIDDM) type II diabetics as compared with controls (BPEI, P = 0.009 and P = 0.005; DMEI, P = 0.004 and P = 0.29). When data from both locations were combined, the difference was even more significant (IDDM, P = 0.001 and NIDDM, P = 0.006). There were no significant differences between the two institutions in gender, type or duration of DM, age at presentation, or frequency of CN involvement.
Diabetic ophthalmoplegia most commonly involves CN 3 and 6, with relative sparing of CN 4. Multiple cranial nerves are affected simultaneously in 2.6% of cases, and consecutive palsies occurred in 3.9% of cases. Type II diabetics with ocular motor CN palsy have significantly less diabetic retinopathy than do controls. This may imply a different pathophysiologic mechanism for these two microvascular complications of DM.
回顾伴有动眼神经（CN）3、4和/或6麻痹的糖尿病患者视网膜病变的临床特征、患病率及严重程度，并确定糖尿病（DM）的类型和病程、视网膜病变的存在与CN麻痹发生之间的关系。
回顾性、对比队列研究。
1991年1月至1997年12月在巴斯科姆·帕尔默眼科研究所（BPEI）以及1994年1月至2001年7月在迪恩·A·麦吉眼科研究所（DMEI）对2229例患有CN 3、4和/或6麻痹的患者进行了病历回顾。共有306例患者符合研究组标准。将威斯康星糖尿病视网膜病变流行病学研究（WESDR）用作对照。
提取人口统计学和临床数据以确定糖尿病性眼肌麻痹患者的特征。将研究人群中关于DM类型和糖尿病视网膜病变程度的数据子集与WESDR对照数据进行比较以进行统计分析。
糖尿病性眼肌麻痹患者中糖尿病视网膜病变的患病率。
在两家机构的2229例患有眼球运动CN麻痹的患者中，306例（13.7%）与DM相关。CN受累频率分别为6例（50.0%）、3例（43.3%）和4例（6.7%）。共有12例患者（3.9%）出现连续性麻痹，8例患者（2.6%）出现同时性麻痹（5例单侧和3例双侧）。在两家机构，与对照组相比，胰岛素依赖型DM（IDDM）和非胰岛素依赖型DM（NIDDM）II型糖尿病患者中，控制DM病程后的视网膜病变患病率均较低（BPEI，P = 0.009和P = 0.005；DMEI，P = 0.004和P = 0.29）。当将两个地点的数据合并时，差异更为显著（IDDM，P = 0.001和NIDDM，P = 0.006）。两家机构在性别、DM类型或病程、就诊年龄或CN受累频率方面无显著差异。
糖尿病性眼肌麻痹最常累及CN 3和6，相对较少累及CN 4。2.6%的病例中多条颅神经同时受累，3.9%的病例出现连续性麻痹。患有眼球运动CN麻痹的II型糖尿病患者的糖尿病视网膜病变明显少于对照组。这可能意味着DM这两种微血管并发症存在不同的病理生理机制。
