Although diabetic autonomic neurop athy involves most or-gans,diagnosis is largely based on c ardiovascular tests.Light reflex pupillography(LRP)non-invasively evaluates pupillary autonomic function.We te sted whether LRP demonstrates autonomic pupillary d ysfunction in diabetics independently from cardiac autonom ic neuropathy(CAN)or peripheral neuropathy(PN).In 36type -II diabetics(39-84years)and 36controls(35-78years),we per-formed LRP.We determined diameter(PD),early and late redilation velocities(DV)as sympathetic parameters and reflex amplitude(RA)and constriction velocity(CV)as parasympathetic pupillary indic es.We assessed the frequency of CAN using heart rate variability tests and e-valuated the frequency of PN using neurological examina-tion,nerve conduction studies,thermal and vibratory threshold determination.Twenty-e ight (77.8%)patients had abnormal pupillography results,but only 20patients(56%)had signs of PN or CAN.In nine patient s with PN,only pupillography identified auto nomic neuropathy.Four patients had pupillary dysfunction but no CAN or PN.In comparison to controls,patients had reduced PD,late DV,RA and CV indicating sympathetic and parasympathetic dysfunction.The incidence and seve rity of pupillary ab-normalities did not differ between p atients with and without CAN or PN.LRP demonstrates sympathetic and parasym-pathetic pupillary dysfunction ind ependently from PN or CAN and thus refines the diagnosis of autonomic neuropa-thy in type -II diabetics.
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