Pupillary autonomic dysfunction in patients with ANCA-associated vasculitis

Moog, Philipp; Eren, Ozan; Kossegg, S.; Valda, K.; Straube, Andreas; Grünke, Mathias; Schulze‐Koops, Hendrik; Witt, Matthias

doi:10.1007/s10286-017-0463-1

Cited by 6 publications

(5 citation statements)

References 22 publications

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“…The pupillary light reflex (PLR) is regulated by the cholinergic system, which mediates pupillary constriction to light stimulation [6]; therefore, quantitative measurement of the pupillary function with automated infrared pupillometry represents an attractive tool for evaluating cholinergic activity in the clinical setting [14][15][16][17][18] and is emerging as a novel monitoring and diagnostic tool in neurological conditions (e.g., Alzheimer's and Parkinson's disease) in which cholinergic deficit is implicated in disease pathogenesis [19][20][21].…”

Section: Introductionmentioning

confidence: 99%

Neuromonitoring of delirium with quantitative pupillometry in sedated mechanically ventilated critically ill patients

et al. 2020

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Background: Intensive care unit (ICU) delirium is a frequent secondary neurological complication in critically ill patients undergoing prolonged mechanical ventilation. Quantitative pupillometry is an emerging modality for the neuromonitoring of primary acute brain injury, but its potential utility in patients at risk of ICU delirium is unknown. Methods: This was an observational cohort study of medical-surgical ICU patients, without acute or known primary brain injury, who underwent sedation and mechanical ventilation for at least 48 h. Starting at day 3, automated infrared pupillometry-blinded to ICU caregivers-was used for repeated measurement of the pupillary function, including quantitative pupillary light reflex (q-PLR, expressed as % pupil constriction to a standardized light stimulus) and constriction velocity (CV, mm/s). The relationship between delirium, using the CAM-ICU score, and quantitative pupillary variables was examined. Results: A total of 59/100 patients had ICU delirium, diagnosed at a median 8 (5-13) days from admission. Compared to non-delirious patients, subjects with ICU delirium had lower values of q-PLR (25 [19-31] vs. 20 [15-28] %) and CV (2.5 [1.7-2.8] vs. 1.7 [1.4-2.4] mm/s) at day 3, and at all additional time-points tested (p < 0.05). After adjusting for the SOFA score and the cumulative dose of analgesia and sedation, lower q-PLR was associated with an increased risk of ICU delirium (OR 1.057 [1.007-1.113] at day 3; p = 0.03). Conclusions: Sustained abnormalities of quantitative pupillary variables at the early ICU phase correlate with delirium and precede clinical diagnosis by a median 5 days. These findings suggest a potential utility of quantitative pupillometry in sedated mechanically ventilated ICU patients at high risk of delirium.

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Section: Introductionmentioning

confidence: 99%

Neuromonitoring of delirium with quantitative pupillometry in sedated mechanically ventilated critically ill patients

et al. 2020

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“…The following parameters were measured with automatic pupillometry system: pupil diameter before and after light stimulus; latency, duration, velocity and amplitude of pupillary constriction; velocity, latency and duration of pupillary dilatation. Amplitude and maximum constriction velocity re ect the active parasympathetic part of the light re ex, whereas the dilatation velocity re ects the active sympathetic part (4) In this study, all static PDs including the scotopic, mesopic low and high photopic PDs were smaller in patient group. Furthermore, the present study found that patients had higher resting PDs than healthy group.…”

Section: Resultsmentioning

confidence: 49%

Static And Dynamic Pupillometric Changes With Silodosin; Selective α1 Adrenoceptor Blocker

Karaca¹,

Kaya²,

Ayyıldız³

et al. 2021

Preprint

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Backround: Intraoperative floopy iris syndrome is a variant of the small pupil syndrome that has been observed during cataract surgery in some patients currently or previously treated with the α1 adrenergic blockers. It is important for cataract surgeons to predict the probable complications, preoperatively. The aim of our study is to evaluate the static and dynamic pupil characteristics of patients treated with silodosin –a selective α1 adrenergic blocker- for Benign Prostate Hypertrophy (BPH) and to compare these values with healthy subjects using an automatic quantitative pupillometry system.Methods: A total of 74 BPH patients treated with silodosin for six months (group 1) and 30 healthy subjects (group 2) were enrolled in this prospective multidisciplinary cross-sectional study. Static and dynamic pupillometric measurements were obtained under optimized conditions and the results were compared between the two groups.Results: Seventy four male patients with a mean age of 63,35±7,21 (46-77) years with BPH treated with silodosin and 30 normal male subjects with a mean age of 63,07±4,73 (52-71) years were analyzed. There were statistically significant differences between the groups with regard to scotopic pupil diameter (PD), high photopic PD, and low photopic PD (p<0.001, for each one). Patient group has statistically significant higher values of amplitude and velocity of pupil contraction and lower values of duration of pupil contraction and latency, duration and velocity of pupil dilation.Conclusion: Static and dynamic pupil characteristics of subjects treated with silodosin for BPH is different from healthy eyes. In addition, our results may have shed light on understanding the risk for IFIS before cataract surgery and thus surgeons can be on the alert and take precautions.

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“…The pupillary light reflex (PLR) is regulated by the cholinergic system, which mediates pupillary constriction to light stimulation [6], therefore quantitative measurement of the pupillary function with automated infrared pupillometry represents an attractive tool for evaluating cholinergic activity in the clinical setting [14][15][16][17][18] and is emerging as a novel monitoring and diagnostic tool in neurological conditions (e.g. Alzheimer's and Parkinson's disease) in which cholinergic deficit is implicated in disease pathogenesis [19][20][21].…”

Section: Introductionmentioning

confidence: 99%

Neuromonitoring of delirium with quantitative pupillometry In sedated mechanically ventilated critically ill patients

Favre

Bernini

Morelli

et al. 2020

Preprint

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Background. Intensive care unit (ICU) delirium is a frequent secondary neurological complication in critically ill patients undergoing prolonged mechanical ventilation. Quantitative pupillometry is an emerging modality for the neuromonitoring of primary acute brain injury, but its potential utility in patients at risk of ICU delirium is unknown. Methods. This was an observational cohort study of medical-surgical ICU patients, without acute or known primary brain injury, who underwent sedation and mechanical ventilation for at least 48 hours. Starting at day 3, automated infrared pupillometry – blinded to ICU caregivers – was used for repeated measurement of the pupillary function, including quantitative pupillary light reflex (q-PLR, expressed as % pupil constriction to a standardized light stimulus) and constriction velocity (CV, mm/sec). The relationship between delirium, using the CAM-ICU score, and quantitative pupillary variables was examined. Results. A total of 59/100 patients had ICU delirium, diagnosed at a median 8 (5-13) days from admission. Compared to non-delirious patients, subjects with ICU delirium had lower values of q-PLR (25 [19-31] vs. 20 [15-28] %) and CV (2.5 [1.7-2.8] vs. 1.7 [1.4-2.4] mm/sec) at day 3, and at all additional time-points tested ( p <0.05). After adjusting for the SOFA score and the cumulative dose of analgesia and sedation, lower q-PLR was associated with an increased risk of ICU delirium (OR 1.057 [1.007-1.113] at day 3; p =0.03). Conclusions. Sustained abnormalities of quantitative pupillary variables at the early ICU phase correlate with delirium and precede clinical diagnosis by a median 5 days. These findings suggest a potential utility of quantitative pupillometry in sedated mechanically ventilated ICU patients at high risk of delirium.

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Pupillary autonomic dysfunction in patients with ANCA-associated vasculitis

Abstract: Patients with AAV exhibit parasympathetic pupillary autonomic dysfunction. Although correlations were weak and not significant, pupillary autonomic dysfunction is rather linked to chronic damage than to active inflammation or symptoms of autonomic dysfunction.

Cited by 6 publications

References 22 publications

Neuromonitoring of delirium with quantitative pupillometry in sedated mechanically ventilated critically ill patients

Neuromonitoring of delirium with quantitative pupillometry in sedated mechanically ventilated critically ill patients

Static And Dynamic Pupillometric Changes With Silodosin; Selective α1 Adrenoceptor Blocker

Neuromonitoring of delirium with quantitative pupillometry In sedated mechanically ventilated critically ill patients

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