Diabetes mellitusun üst gözkapağı ve pupillaya etkileri
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Date
2012
Authors
Yıldırım, Musa Yılmaz
Journal Title
Journal ISSN
Volume Title
Publisher
Uludağ Üniversitesi
Abstract
Bu çalışmanın amacı, diabetes mellitusun (DM) üst göz kapağı ve pupillaya etkilerini incelemektir. Bunun için DM'lu hastalar göz kapağı açıklığı ve pupilla boyutları açısından normal bireylerle karşılaştırıldı. Blefaroptozis ile pupiller otonom sempatik nöropati arasında bir bağıntı olup olmadığı incelendi. Ayrıca, göz kapağı ve pupilla ölçümleriyle, diyabetik retinopati (DR) ve kardiak otonomik nöropati (KON) ile ilişkili olup olmadığı değerlendirildi.Mart 2009 - Aralık 2011 tarihleri arasında, Uludağ Üniversitesi Tıp Fakültesi Göz Hastalıkları kliniğinde, 110 DM'lu hasta (64 erkek, 46 kadın; ortalama yaş: 64,2±4,5 yıl) ve 110 sağlıklı bireyde (63 erkek, 47 kadın; ortalama yaş: 64,4±4,5 yıl) göz kapağı ve pupilla ölçümleri yapıldı. Ayrıca, DM'lu hastalarda DR ve KON varlığı araştırıldı.Göz kapağı ölçümleri biyomikroskopik infrared fotoğrafi, pupilla ölçümleri otomatik infrared pupillometri cihazıyla (Neuroptics PLR-200, LA, USA) yapıldı. Apraklonidin damla (%0,5) testiyle göz kapağı ve pupillanın sempatik denervasyon aşırı duyarlılığı araştırıldı.Ortalama göz kapağı aralığı ve kenar-refleks uzaklığı (KRU), DM grubunda, sırasıyla, 8,22±1,36 mm ve 3,01±0,91 mm, sağlıklı kontrol grubunda 9,34±1,32 mm ve 4,11±0,91 mm'di (P<0,001). Tüm pupilla ölçümleri (minimum ve maksimum pupilla çapları, pupillanın daralma ve genişleme hızı ve latans) açısından DM ve kontrol grubu arasında anlamlı farklılık vardı (P<0,001). Ortalama maksimum pupilla çapı, DM grubunda 4,08±0,83 mm, kontrol grubunda 5,30±0,76 mm'di (P<0,001). Diyabetli hastalarda pupillanın çapı daha küçük, ışık uyaranla daralma ve tekrar genişleme yanıtları daha az ve daha yavaştı. Işık uyaranla pupiller daralmanın başlangıcı arasında geçen süre (latans, sn) daha uzundu. Apraklonidin damla, DM grubunda göz kapağı aralığı ve KRU'da ortalama olarak 1,09±0,72 mm ve 0,87±0,59 mm; kontrol grubunda, ortalama olarak 0,15±0,55 mm ve 0,13±0,50 mm artışa neden oldu (P<0,001). Diabetes mellituslu hastalarda %0,5 apraklonidin damladan sonra tüm pupilla parametrelerinde değişiklik oldu. Maksimum pupilla çapı, minimum pupilla çapı ve latans değerleri arttı. Pupilla daralma yüzdesi, ortalama ve maksimum daralma hızı, ortalama genişleme hızı ve %75 genişleme için geçen süre değerleri ise azaldı (P<0,001). Kontrol grubunda apraklonidin damla ile maksimum ve minimum pupilla çapları, ortalama genişleme hızı değerlerinde anlamlı farklılık gözlenmedi (p>0.05). Bu grupta apraklonidin damla ortalama daralma hızı, daralma yüzdesi, maksimum daralma hızı, %75 genişleme için geçen süre değerlerinde anlamlı bir azalma (P<0,001) ve latans değerinde ise anlamlı bir uzamaya yolaçtı (P=0,001). Diabetes mellitus grubunda 21 hastada (%19) DR bulgusu yoktu, 89 hastada (%81) DR bulgusu saptandı. Kardiyolojik muayenede 110 DM'lu hastadan 97'sinde (%88) KON saptandı. Diabetes mellituslu hastalarda kapak açıklığı ne kadar dar ise pupilla da o kadar küçük olmak eğilimindeydi. Bu iki değişken arasındaki bağıntılar anlamlılık sınırına yakındı (P=0,06 ve P=0,07).Bu çalışma, DM'un subklinik bir ptozise ve miyozise yol açabileceğini gösterir. Diyabetli hastalarda, apraklonidin damlayla göz kapağı ve pupilla anormalliklerinin düzelmesi, bu anormalliklerin sempatik denervasyondan kaynaklanabileceği görüşünü destekler.
The aim of this study was to analyse effects of diabetes mellitus (DM) on the upper eyelid and pupil. For his purpose, patients with DM were compared with normal individuals for eyelid aperture and pupil diameters. It was studied whether there was a relationship between blepharoptosis and pupillary autonomic sympathetic neuropathy in patients with DM. In addition, we evaluated whether there was a correlation between eyelid and pupillary measurements, diabetic retinopathy (DR) and cardiac autonomic neuropathy (CAN).Measurements of the upper eyelid and pupil were performed in 110 diabetic patients (64 male, 46 female; mean age: 64,2±4,5 years) and 110 healthy subjects (63 male, 47 female; mean age: 64,4±4,5 years) at the Uludag University Ophthalmology Department between March 2009-December 2011. Also, the presence of DR and CAN were investigated in patients with DM.The measurements of the upper eyelid were performed with biomicroscopic infrared photography and the pupil measurements were made with an automatic pupillometry (Neuroptics PLR-200, LA, USA). With the use of %0.5 apraclonidine test the hypersensitivity of upper eyelid and sympathetic denervation of pupil were studied.The mean palpebral aperture and margin reflex distances (MRD) were 8.22±1.36 mm and 3,01±0,91 mm in the DM group and 9,34±1,32 mm and 4,11±0,91 mm in the control group, respectively (P<0,001). There were significant differences between the DM and control groups for the pupil measurements (minimum and maximum pupillary diameters, the velocity of pupil dilation, constriction and latency) (P<0,001). The mean of maximum pupillary diameter was 4,08±0,83 in the DM group and 5,30±0,76 in the control group. In diabetic patients, the pupillary diameter was smaller, the constriction response to light stimulus and re-dilation were reduced and slower. The time interval between light stimulus and the initiation of pupil constriction (latency, sec) were longer.The apraclonidine test led to an average increase of palpebral aperture and MRD as 1.09±0.72 mm and 0.87±0.59 mm in the DM group and 0.15±0.55 mm and 0.13±0.50 mm in the control group (P<0,001). In diabetic patients all pupil parameters were changed significantly after 0,5% apraclodine test. The values of maximum and minimum pupillary diameters and latency were increased. The percentage of pupillary constriction, mean and maximum velocities of constriction, mean velocity of dilation and the time to 75% pupillary dilation were decreased. Whereas no significant difference was noted in the control group after apraclonidine test for maximum and minimum pupillary diameters, mean velocity of dilation (p>0,05). In this group, the apraclonidine eyedrop caused a significant decrease in mean velocity of pupillary constriction and time to 75% dilation (p<0,001); and an increase in the latency (P=0,001).In the DM group 89 patients (81%) had DR and 21 patients (19%) not. According to the cardiologic examination, 97 (88%) of 110 diabetic patients had CAN.In diabetic patients, the pupil tended to be smaller when the palpebral aperture was narrower. The correlations between these two variables were close to significance level (P=0,06, P=0,07).This study shows that DM may cause a subclinical ptosis and miosis, Improvement of these eyelid and pupillary abnormalities with apraclonidine eyedrop in DM patients, supports that these abnormalities may be resulted from sympathetic denervation.
The aim of this study was to analyse effects of diabetes mellitus (DM) on the upper eyelid and pupil. For his purpose, patients with DM were compared with normal individuals for eyelid aperture and pupil diameters. It was studied whether there was a relationship between blepharoptosis and pupillary autonomic sympathetic neuropathy in patients with DM. In addition, we evaluated whether there was a correlation between eyelid and pupillary measurements, diabetic retinopathy (DR) and cardiac autonomic neuropathy (CAN).Measurements of the upper eyelid and pupil were performed in 110 diabetic patients (64 male, 46 female; mean age: 64,2±4,5 years) and 110 healthy subjects (63 male, 47 female; mean age: 64,4±4,5 years) at the Uludag University Ophthalmology Department between March 2009-December 2011. Also, the presence of DR and CAN were investigated in patients with DM.The measurements of the upper eyelid were performed with biomicroscopic infrared photography and the pupil measurements were made with an automatic pupillometry (Neuroptics PLR-200, LA, USA). With the use of %0.5 apraclonidine test the hypersensitivity of upper eyelid and sympathetic denervation of pupil were studied.The mean palpebral aperture and margin reflex distances (MRD) were 8.22±1.36 mm and 3,01±0,91 mm in the DM group and 9,34±1,32 mm and 4,11±0,91 mm in the control group, respectively (P<0,001). There were significant differences between the DM and control groups for the pupil measurements (minimum and maximum pupillary diameters, the velocity of pupil dilation, constriction and latency) (P<0,001). The mean of maximum pupillary diameter was 4,08±0,83 in the DM group and 5,30±0,76 in the control group. In diabetic patients, the pupillary diameter was smaller, the constriction response to light stimulus and re-dilation were reduced and slower. The time interval between light stimulus and the initiation of pupil constriction (latency, sec) were longer.The apraclonidine test led to an average increase of palpebral aperture and MRD as 1.09±0.72 mm and 0.87±0.59 mm in the DM group and 0.15±0.55 mm and 0.13±0.50 mm in the control group (P<0,001). In diabetic patients all pupil parameters were changed significantly after 0,5% apraclodine test. The values of maximum and minimum pupillary diameters and latency were increased. The percentage of pupillary constriction, mean and maximum velocities of constriction, mean velocity of dilation and the time to 75% pupillary dilation were decreased. Whereas no significant difference was noted in the control group after apraclonidine test for maximum and minimum pupillary diameters, mean velocity of dilation (p>0,05). In this group, the apraclonidine eyedrop caused a significant decrease in mean velocity of pupillary constriction and time to 75% dilation (p<0,001); and an increase in the latency (P=0,001).In the DM group 89 patients (81%) had DR and 21 patients (19%) not. According to the cardiologic examination, 97 (88%) of 110 diabetic patients had CAN.In diabetic patients, the pupil tended to be smaller when the palpebral aperture was narrower. The correlations between these two variables were close to significance level (P=0,06, P=0,07).This study shows that DM may cause a subclinical ptosis and miosis, Improvement of these eyelid and pupillary abnormalities with apraclonidine eyedrop in DM patients, supports that these abnormalities may be resulted from sympathetic denervation.
Description
Keywords
Diabetes mellitus, Diyabetik otonom nöropati, Pupilla, Pupillometri, Denervasyon hipersensivitesi, Diabetic autonomic neuropathy, Pupil, Pupillometry, Denervation hypersensitvty
Citation
Yıldırım, M. Y. (2012). Diabetes mellitusun üst gözkapağı ve pupillaya etkileri. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.