מתוך medicontext.co.il
WESTPORT, CT (Reuters Health) – Assessment of pupillary denervation hypersensitivity to dilute pilocarpine is an inexpensive method of detecting early diabetic autonomic neuropathy, according to a report in the October issue of the British Journal of Ophthalmology.
In a case-control study, Dr. Mark Cahill and colleagues, from University College Dublin in Ireland, evaluated autonomic pupillary changes in type 1 and 2 diabetics who had no clinical evidence of diabetic autonomic neuropathy, as well as in age-matched controls. Seventy-two patients with type 1 diabetes and 69 with type 2 diabetes were compared to 120 control subjects.
Confirming previous studies, the researchers found that on static infrared pupillography, the mean dark-adapted pupil was significantly smaller in diabetics than in controls. "All diabetic patients except those with type 1 disease for less than 5 years' duration had significantly more response to dilute pilocarpine than controls, demonstrating parasympathetic denervation of the pathway responsible for pupil constriction."
Cardiovascular autonomic function was normal in a high proportion of patients, especially when it was assessed by the Valsalva ratio. This confirms previous reports that pupillary parasympathetic changes occur before parasympathetic cardiovascular changes in patients with diabetes, Dr. Cahill and his associates note.
"We agree with previous reports that measurement of the pupil size is a useful indicator of autonomic function in diabetic patients, but our findings demonstrate that denervation hypersensitivity of the pupil to dilute pilocarpine is also a good parameter of early autonomic dysfunction," they conclude.
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