Graves hastalığında pupiller yanıt değişiklikleri

Yıl 2023, Cilt: 48 Sayı: 2, 361 - 368, 02.07.2023

Gamze Yıldırım Biçer , Çağatay Emir Önder , Kürşad Ramazan Zor

https://doi.org/10.17826/cumj.1229467

Öz

Amaç: Bu çalışmanın amacı, Graves hastalığında pupiller kontraksiyon ve dilatasyon yanıt değişikliklerini araştırmaktı.
Gereç ve Yöntem: Hasta grubu 55 ötroid Graves hastasından ve kontrol grubu 55 sağlıklı bireyden oluşuyordu. Tüm katılımcıların sağ gözlerinden elde edilen veriler kullanıldı. Otomatik pupillometri ile statik (skotopik, mezopik, fotopik) ve dinamik pupillometri ölçümleri yapıldı. Dinamik ölçümlere göre ortalama pupil dilatasyon hızı hesaplandı. Hasta ve kontrol grupları arasında statik ölçümler, dinamik ölçümler ve ortalama pupil dilatasyon hızı verileri karşılaştırıldı.
Bulgular: Tüm statik ve dinamik değerler ve ortalama pupil dilatasyon hızı açısından iki grup arasında fark yoktu. Ortalama skotopik pupil çapı Graves grubunda 5,41±0,776 mm, kontrol grubunda 5,55±0,747 mm; ortalama mezopik pupil çapı Graves grubunda 4,39±0,721 mm, kontrol grubunda 4,17±0,640 mm; ortalama fotopik pupil çapı Graves grubunda 3,45 ±0,549 mm, kontrol grubunda 3,29±0,679 mm; ortalama dinamik pupil çapı 0. saniye Graves grubunda 3,54±0,541 mm, kontrol grubunda 3,48±0,708 mm; 18. saniyede ortalama pupil dilatasyon hızı Graves grubunda 0,116±0,031 mm/sn, kontrol grubunda 0,128±0,040 mm/sn olarak saptandı. Yaş pupiller parametreleri etkileyen bağımsız bir faktör olarak bulundu.
Sonuç: Graves hastalığında muhtemel bir otonomik bozukluk bildirilse de ötroidi durumundaki hastaların pupiller parametrelerinin etkilenmediği sonucuna vardık. Ötroidi durumunda pupiller yanıtlar etkilenmiyor gibi görünse de hipotroidi ve hipertroidi hastalarının da dahil edildiği çalışmalara ihtiyaç vardır.

Anahtar Kelimeler

otonom sinir sistemi, Graves hastalığı, pupil dilatasyon hızı, pupillometri, tiroid fonksiyon testleri

Pupillary response changes in Graves' disease

Öz

Purpose: The aim of this study was to investigate pupillary contraction and dilatation response changes in Graves' disease.
Materials and Methods: The patient group consisted of 55 euthyroid Graves patients and the control group consisted of 55 healthy individuals. Data from the right eyes of all participants were used. Static (scotopic, mesopic, photopic) and dynamic pupillometry measurements were performed with automatic pupillometry. The mean pupil dilatation speed was calculated according to dynamic measurements. Static measurements, dynamic measurements and the mean pupil dilatation speed data were compared between the patient and control groups.
Results: There was no statistically significant difference between two groups in all static and dynamic values and the mean pupil dilatation speed. The mean scotopic pupil diameter was 5.41±0.776 mm in Graves’ group and 5.55±0.747 mm in the control group. The mean mesopic pupil diameter was 4.39±0.721 in Graves’ group and 4.17±0.640 mm in the control group. The mean photopic pupil diameter was 3.45 ±0,549 mm in Graves’ group and 3.29±0.679 mm in the control group. The mean dynamic pupil diameter 0th second was 3, 54±0.541 mm in Graves’ group and 3.48±0.708 mm in the control group. The mean speed of pupil dilatation at 18th second was 0.116±0.031 mm/sec in Graves’ group and 0.128±0.040 mm/sec in the control group. Age was found to be an independent factor on pupillary parameters.
Conclusion: The pupillary parameters of patients with euthyroid hormone levels were not affected. While pupillary responses appeared not to be affected in the case of euthyroidism, more studies including patients with hypothyroidism and hyperthyroidism are needed.

Anahtar Kelimeler

autonomic nervous system, pupil dilatation speed, pupillometry, thyroid function tests, Graves

Kaynakça

• Kahaly GJ. Management of graves thyroidal and extrathyroidal disease: an update. J Clin Endocrinol Metab. 2020;105:3704-20.
• Ehlers M, Schott M, Allelein S. Graves' disease in clinical perspective. Front Biosci (Landmark Ed). 2019;24:35-47.
• Weiler DL. Thyroid eye disease: a review. Clin Exp Optom. 2017;100:20-25.
• Eslami F, Borzouei S, Khanlarzadeh E, Seif S. Prevalence of increased intraocular pressure in patients with graves' ophthalmopathy and association with ophthalmic signs and symptoms in the north-west of Iran. Clin Ophthalmol. 2019;13:1353-59.
• Barrio-Barrio J, Sabater AL, Bonet-Farriol E, Velázquez-Villoria Á, Galofré JC. Graves' ophthalmopathy: VISA versus EUGOGO classification, assessment, and management. J Ophthalmol. 2015;2015:249125.
• Hamada N, Okamoto Y, Yoshida H, Tsumura K, Nakamura Y, Noh JY. Sympathetic overactivity in the development of eyelid retraction in a patient with euthyroid graves' disease evaluated by accommodation. Endocr J. 2000;47:623-8.
• Gon Y, Sakaguchi M, Oyama N, Mochizuki H. Diagnostic utility of contrast-enhanced 3D T1-weighted imaging in acute cerebral infarction associated with graves disease. J Stroke Cerebrovasc Dis. 2017;26:e38-40.
• Rodríguez-Alonso X, Gutiérrez-Jorrín S, Bonnin-Arias C, Rubio-Corgo S, Arregui-Olaizola C, Quezada-Sánchez J, et al. Mesopic pupillary reflex in patients treated with fluoxetine. Actas Esp Psiquiatr. 2020;48:47-53.
• Serbest Ceylanoglu K, Sen EM, Sekeroglu MA. Static and dynamic pupillary features in graves' ophthalmopathy. Clin Exp Optom. 2022:1-5.
• 10.Eckstein A, Dekowski D, Führer-Sakel D, Berchner-Pfannschmidt U, Esser J. Graves' ophthalmopathy. Ophthalmologe. 2016;113:349-64; quiz 465-6.
• Weinstein JM, Van Gilder JC, Thompson HS. Pupil cycle time in optic nerve compression. Am J Ophthalmol. 1980;89:263-7.
• Noh JY, Nakamura Y, Ito K, Inoue Y, Abe Y, Hamada N. Sympathetic overactivity of intraocular muscles evaluated by accommodation in patients with hyperthyroidism. Thyroid. 1996;6:289-93.
• Higashi JT, Ishikawa S, Mukuno K, Watanabe A. Pupillary analyses in graves' disease. Jpn J Ophthalmol. 1982;26:213-23.
• Hreidarsson AB, Laurberg P.Evaluation of pupillary function in thyroid disease. Acta Ophthalmol (Copenh). 1982;60:641-6.
• Hall CA, Chilcott RP. Eyeing up the future of the pupillary light reflex in neurodiagnostics. Diagnostics (Basel). 2018;8:19.
• Roldan EC, Nigrin G. Peripheral neuritis after methimazole therapy. N Y State J Med. 1972;72:2898-900.
• Tripodi PF, Ruggeri RM, Campennì A, Cucinotta M, Mirto A, Lo Gullo R, et al. Central nervous system vasculitis after starting methimazole in a woman with graves' disease. Thyroid. 2008;18:1011-3