| Pupillary autonomic denervation with increasing duration of diabetes mellitus. | |
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MedLine Citation:
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PMID: 11567969 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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 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. CONCLUSIONS: 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. |
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Authors:
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M Cahill; P Eustace; V de Jesus |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: The British journal of ophthalmology Volume: 85 ISSN: 0007-1161 ISO Abbreviation: Br J Ophthalmol Publication Date: 2001 Oct |
Date Detail:
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Created Date: 2001-09-24 Completed Date: 2001-10-25 Revised Date: 2009-11-18 |
Medline Journal Info:
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Nlm Unique ID: 0421041 Medline TA: Br J Ophthalmol Country: England |
Other Details:
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Languages: eng Pagination: 1225-30 Citation Subset: IM |
Affiliation:
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The Institute of Ophthalmology, University College Dublin, Mater Misericordiae Hospital, 60 Eccles Street, Dublin 7, Ireland. cahill001@mc.duke.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Aged Aged, 80 and over Autonomic Nervous System Diseases / complications*, physiopathology Case-Control Studies Child Child, Preschool Cocaine / pharmacology Dark Adaptation / physiology Diabetic Neuropathies / complications*, physiopathology Disease Progression Female Humans Hypotension, Orthostatic / etiology Male Middle Aged Miotics / pharmacology Mydriatics / pharmacology Normal Distribution Pilocarpine / pharmacology Pupil / drug effects Pupil Disorders / etiology*, physiopathology Statistics, Nonparametric Time Factors Valsalva Maneuver / physiology |
| Chemical | |
Reg. No./Substance:
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0/Miotics; 0/Mydriatics; 50-36-2/Cocaine; 92-13-7/Pilocarpine |
| Comments/Corrections | |
Comment In:
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Br J Ophthalmol. 2002 Nov;86(11):1319
[PMID:
12386106
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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