Sixty-one control subjects with other causes of unilateral dilated pupils were included for comparison with a mean age of 49.9 ± 14.4 years 28 subjects were tested with 0.125% pilocarpine and 33 with 0.0625% pilocarpine. In the present study, we compared the diagnostic ability of the two concentrations of pilocarpine, 0.125% versus 0.0625%, for detecting denervation supersensitivity in unilateral Adie’s tonic pupil among other causes of unilateral dilated pupils. Pupillary changes, and in particular, changes in anisocoria, after administration of dilute pilocarpine in unilateral Adie’s tonic pupil can be quantified by digital pupillometry, which can help clinicians distinguish it from other types of physiological and pathological anisocoria. Recently, digital pupillometry has been developed, which allows quantification of pupillary light reflex (PLR) parameters in an objective manner 12, 13. However, to the best of our knowledge, no previous study has compared the diagnostic ability of these two concentrations.Ī few studies have reported objective quantification of the pupil size in Adie’s tonic pupil 8, 11. To overcome this limitation, 0.0625% pilocarpine instillation was suggested as an alternative test to detect denervation supersensitivity in Adie’s tonic pupil 10. However, false positive responses to dilute pilocarpine are not uncommon, where Younge and Buski 9 found significant constriction in 15% of the normal pupils after instillation of 0.1% pilocarpine. Until now, 0.125% dilute pilocarpine has been generally recommended as the standard pharmacologic agent for demonstrating cholinergic supersensitivity of the iris sphincter 2, 4. Denervation supersensitivity is a characteristic sign in Adie’s tonic pupil that is confirmed by pharmacologic testing with a direct-acting weak muscarinic agonist, dilute pilocarpine 1, 3, 6, 7, 8. It is characterized by loss of direct and indirect pupillary light reflexes, accommodative paresis, segmental palsy of the iris, and denervation supersensitivity 1, 3, 4, 5. Adie’s tonic pupil is caused by damage to the postganglionic parasympathetic nerve of the iris sphincter muscle. Digital pupillometry is a reliable method for assessing denervation supersensitivity in Adie's tonic pupil.ĭilated pupils result from various factors, such as oculomotor nerve palsy, trauma to the iris sphincter, acute angle closure glaucoma, and pharmacologic inhibition of the parasympathetic pathway 1, 2. This study confirmed that pupillary constriction with 0.0625% pilocarpine is better than 0.125% pilocarpine for detecting denervation supersensitivity in Adie’s tonic pupil. In the 0.0625% group, the change in maximal pupil diameter of ≥ 0.5 mm after topical pilocarpine instillation showed 100% sensitivity and 82.8% specificity for detecting Adie’s tonic pupil. Diagnostic ability of the dilute pilocarpine test for detecting denervation supersensitivity in unilateral Adie’s tonic pupil was significantly better in the 0.0625% group than in the 0.125% group (AUC = 0.954 vs. Diagnostic accuracy of two different concentrations of the dilute pilocarpine test, 0.125% group versus 0.0625% group, were compared by area under the receiver operating characteristic curve (AUC). Pupillary light reflex was recorded with a dynamic pupillometer at baseline and at 30–40 min after instilling one of the two concentrations of dilute pilocarpine. Subjects underwent the dilute pilocarpine test with one of the two concentrations, 0.125% or 0.0625%. This retrospective, observational, case–control study involved 117 subjects, consisting of 56 patients with unilateral Adie’s tonic pupil and 61 controls with other causes of unilateral dilated pupils. We have compared the diagnostic ability of different concentrations of 0.125% and 0.0625% dilute pilocarpine for detecting denervation supersensitivity in unilateral Adie’s tonic pupil.
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