糖尿病患者のどう孔異常

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タイトル別名
  • Pupillary Abnormalities in Diabetics
  • トウニョウビョウ カンジャ ノ ドウコウ イジョウ

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Quantitative analysis of pupillary light reflexes was performed in 60 diabetic patients using computerized infrared videopupillography and the “open loop” stimulatory technique. The visual acuity of all patients studied was at least 0.8 and there were no ophthalmoscopic signs of retinopathy in the area stimulated by the light, thereby ensuring roughly uniform retinal sensitivity.<BR>Pupillographic analysis revealed a normal latency time and abnormalities such as miotic pupil area (PA), reduced constriction area, reduced maximum velocities of constriction (VCmax) and dilatation (VDmax) compared to sex and age matched controls. These changes resembled the findings obtained in the pupil of normal subjects topically instilled with dilute pilocarpine, indicating the pupil of the diabetics to be cholinergic. We could estimate the degree of pupillary abnormalities only by determination of PA, since the reduction of PA correlated closely with the reduction of VCmax or VDmax.<BR>Such abnormal responses were obtained from 8 (67%) fo 12 patients without peripheral neuropathy (PN), 21 (81%) of 26 patients with mild PN, and all of 18 patients with severe PN. The degree of the abnormalities appeared to parallel the progression of PN. The pupillary abnormalities were more closly correlated to the development of paresthesia or the reduction of vibratory sensation and less related to the reduction of deep tendon reflexes or motor nerve conduction velocity. A correlation was also found between the degree of pupillary abnormalities and the duration of diabetes, but not between the degree of pupillary abnormalities and the control of FBS.<BR>Furthermore, a close correlation existed between the degree of pupillary abnormalities and the severity of retinopathy. Abnormal responses were obtained from 20 (69%) of 29 patients without retinopathy, and all of 27 patients with retinopathy. These findings suggest the possibility that autonomic neuropathy may play a role in the pathogenesis of retinopathy.<BR>It is concluded that a reduction of PA represents a useful warning for the development of diabetic neuropathy and even retinopathy. Incorporation of such tests of pupillary functions into routine examinations should be beneficial.

収録刊行物

  • 糖尿病

    糖尿病 25 (5), 581-587, 1982

    一般社団法人 日本糖尿病学会

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