Department of Endocrinology and Metabolic Diseases, Ankara Training and Research Hospital, Ankara, Turkey.
Department of Ophthalmology, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey.
Int Ophthalmol. 2024 Nov 12;44(1):428. doi: 10.1007/s10792-024-03355-8.
Pupillary contraction and dilatation are organized by the autonomic nervous system, which can also be affected by Graves' disease (GD). In this study, it was aimed to investigate the static and dynamic pupillary responses of Graves' patients in the hyperthyroid and euthyroid periods and to compare these results with the values obtained from healthy controls.
48 eyes of 24 newly diagnosed Graves' patients with clinical activity score ≤ 2 and 46 eyes of 23 age- and sex-matched healthy controls were included in the study. Patients with GD were evaluated separately in the hyperthyroid phase and after euthyroidism was achieved. After a detailed ophthalmological examination, patients undergone automatic quantitative testing to obtain static (scotopic, mesopic, low photopic, and high photopeak pupil diameters) and dynamic (pupillary contraction amplitude, latency, velocity and duration, and pupil dilation latency, velocity and duration) pupil measurements.
A statistically significant difference was found between the control [4.7 mm (3.7-6.9)] and hyperthyroid [5.1 mm (3.6-7.8)] groups for mesopic pupil diameter (p = 0.003). Dynamic pupillometry measurements showed that hyperthyroid and euthyroid groups had greater pupil dilation delay and lower pupil dilation rate compared to the control group (p < 0.05 for all).
Even in the absence of orbitopathy, patients with GD have autonomic dysregulation of pupillary functions. These changes, which prevail in the hyperthyroid phase, do not reverse when the TSH receptor antibody titer drops and the patient becomes euthyroid. Future studies are needed to elucidate the mechanism of these pupillary changes in GD.
瞳孔收缩和扩张是由自主神经系统组织的，自主神经系统也可能受到 Graves 病（GD）的影响。本研究旨在探讨甲状腺功能亢进和甲状腺功能正常期 Graves 病患者的静态和动态瞳孔反应，并将这些结果与健康对照组的结果进行比较。
本研究纳入了 24 例新诊断的 Graves 病患者（临床活动评分≤2）的 48 只眼和 23 例年龄和性别匹配的健康对照者的 46 只眼。GD 患者分别在甲状腺功能亢进期和甲状腺功能正常后进行评估。在详细的眼科检查后，患者接受自动定量测试以获得静态（暗适应、中间光、低光和高光瞳孔直径）和动态（瞳孔收缩幅度、潜伏期、速度和持续时间以及瞳孔扩张潜伏期、速度和持续时间）瞳孔测量。
与对照组[4.7mm（3.7-6.9）]相比，甲状腺功能亢进组[5.1mm（3.6-7.8）]的中间光瞳孔直径有统计学意义（p=0.003）。动态瞳孔测量结果显示，甲状腺功能亢进组和甲状腺功能正常组与对照组相比，瞳孔扩张延迟更大，瞳孔扩张率更低（所有 p<0.05）。
即使没有眼外肌病，GD 患者的瞳孔功能也存在自主神经调节紊乱。这些变化在甲状腺功能亢进期更为明显，当 TSH 受体抗体滴度下降且患者甲状腺功能正常时，这些变化不会逆转。需要进一步的研究来阐明 GD 中这些瞳孔变化的机制。
