Ophthalmology Department, Mustafa Kemal University, Hatay, Turkey.
Ophthalmology Department, Hatay State Hospital, Hatay, Turkey.
Arq Bras Oftalmol. 2021 Jan-Feb;84(1):37-44. doi: 10.5935/0004-2749.20210007.
We aimed to evaluate the use of automated quantitative static and dynamic pupillometry in screening patients with type 2 diabetes mellitus and different stages of diabetic retinopathy.
155 patients with type 2 diabetes mellitus (diabetes mellitus group) were included in this study and another 145 age- and sex-matched healthy individuals to serve as the control group. The diabetes mellitus group was divided into three subgroups: diabetes mellitus without diabetic retinopathy (No-diabetic retinopathy), nonproliferative diabetic retinopathy, and proliferative diabetic retinopathy. Static and dynamic pupillometry were performed using a rotating Scheimpflug camera with a topography-based system.
In terms of pupil diameter in both static and dynamic pupillometry (p<0.05), statistically significant differences were observed between the diabetes mellitus and control groups and also between the subgroups No-diabetic retinopathy, nonproliferative diabetic retinopathy, and proliferative diabetic retinopathy subgroups. But it was noted that No-diabetic retinopathy and nonproliferative diabetic retinopathy groups have showed similarities in the findings derived from static pupillometry under mesopic and photopic conditions. The two groups also appeared similar at all points during the dynamic pupillometry (p>0.05). However, it could be concluded that the proliferative diabetic retinopathy group was significantly different from the rest of the subgroups, No-diabetic retinopathy and nonproliferative diabetic retinopathy groups, in terms of all the static pupillometry measurements (p<0.05). The average speed of dilation was also significantly different between the diabetes mellitus and control groups and among the diabetes mellitus subgroups (p<0.001). While weak to moderate significant correlations were found between all pupil diameters in static and dynamic pupillometry with the duration of diabetes mellitus (p<0.05 for all), the HbA1c values showed no statistically significant correlations with any of the investigated static and dynamic pupil diameters (p>0.05 for all).
This study revealed that the measurements derived from automated pupillometry are altered in patients with type 2 diabetes mellitus. The presence of nonproliferative diabetic retinopathy does not have a negative effect on pupillometry findings, but with proliferative diabetic retinopathy, significant alterations were observed. These results suggest that using automated quantitative pupillometry may be useful in verifying the severity of diabetic retinopathy.
评估使用自动化定量静态和动态瞳孔测量在筛查 2 型糖尿病患者和不同阶段糖尿病性视网膜病变中的应用。
本研究纳入了 155 例 2 型糖尿病患者（糖尿病组）和 145 例年龄和性别匹配的健康个体作为对照组。糖尿病组分为三组：无糖尿病性视网膜病变（无糖尿病性视网膜病变）、非增生性糖尿病性视网膜病变和增生性糖尿病性视网膜病变。使用基于地形图的旋转 Scheimpflug 相机进行静态和动态瞳孔测量。
在静态和动态瞳孔测量的瞳孔直径方面（p<0.05），糖尿病组与对照组以及无糖尿病性视网膜病变、非增生性糖尿病性视网膜病变和增生性糖尿病性视网膜病变亚组之间均存在统计学差异。但是，需要注意的是，无糖尿病性视网膜病变和非增生性糖尿病性视网膜病变组在明适应和暗适应条件下的静态瞳孔测量结果存在相似之处。在动态瞳孔测量的所有时间点，这两个组之间也表现出相似（p>0.05）。然而，可以得出结论，与其余亚组（无糖尿病性视网膜病变和非增生性糖尿病性视网膜病变组）相比，增生性糖尿病性视网膜病变组在所有静态瞳孔测量方面均存在显著差异（p<0.05）。两组之间的平均扩张速度也存在显著差异（p<0.001）。尽管在静态和动态瞳孔测量的所有瞳孔直径与糖尿病持续时间之间存在弱到中度显著相关性（p<0.05），但糖化血红蛋白值与任何调查的静态和动态瞳孔直径之间均无统计学显著相关性（p>0.05）。
本研究表明，自动化瞳孔测量得出的测量值在 2 型糖尿病患者中发生了改变。无增生性糖尿病性视网膜病变不会对瞳孔测量结果产生负面影响，但出现增生性糖尿病性视网膜病变时，会观察到显著的变化。这些结果表明，使用自动化定量瞳孔测量可能有助于验证糖尿病性视网膜病变的严重程度。
