球后视神经炎患者的瞳孔对光反射特征

目的 了解球后视神经炎(RON)患者的瞳孔对光反射特征，探讨瞳 孔对光反射检查在RON诊断和治疗中的临床应用价值。 方法 用瞳孔测试仪分别检测3 5例临床确诊的RON患者35只患眼治疗前(发病期)后、对侧眼以及正常对照组50例100只眼的瞳孔对光反射。患者组年龄10~ 58岁，平均年龄30.4岁；对照组与患者组年龄、性别无差异 。检查的对光反射参数包括瞳孔面积、瞳孔对光反射的最大反应幅度、潜伏期和最大反应速度。 结果 在RON的发病期，患眼瞳孔对光反射的反应潜伏期延长、最大反应幅度减小，与正常照 组相比差异 有非常显著的统计学意义。治疗后，随着病情改善、视力恢复，患眼瞳孔对光反射的反应潜伏期、最大反应幅度等逐渐恢复，与发病期相比差异有统计学意义，但与正常对照组比较仍然有显著差异。患眼发病期和治疗后，对侧眼瞳孔也表现为反应潜伏期和最大反应幅度下降，但与对照组相比，其差异均无统计学意义。 结论 RON患眼的瞳孔对光反射反应潜伏期延长、最大反应幅度减小。瞳孔对光反射检查有于 对RON做出早期诊断并监测其病情变化。 (中华眼底病杂志，2006，22：370-372）     

正常人瞳孔对光反射的生物力学性能与年龄的相关性

目的：:初步探索正常人瞳孔对光反射曲线的生物力学模型,了解各分量参数与年龄的关系。方法：:系列病例研究。使用Oculus Keratograph 4角膜地形图仪的Pupillometer程序收集2015年2月至2018年7月在温州医科大学附属眼视光医院视光诊疗中心就诊的143名眼部正常受试者一眼的瞳孔对光反射曲线数据,...     

我国正常中青年暗适应下的瞳孔大小

目的　了解我国正常中青年群体中瞳孔在暗适应条件下的大小。方法　用红外线瞳孔测试仪 (pupilometer)测量93例正常人 (186眼 )在暗环境下的瞳孔大小。检测对象年龄31.0岁± 7.9岁 (16～ 4 6岁 ) ,所有测试者在暗适应 2min后由同一检查者进行检查。其中 4 0名受检者在不同时间由同一检查者重复检查一次。分析所得数据并对检查进行可重复性评价。结果　对于所有受试者 ,暗适应下右眼瞳孔平均直径为 7.0 4mm± 0 .93mm(4.85～ 8 89mm ) ;左眼瞳孔平均直径为 7.11mm± 0 .86mm(4.99～ 9.13mm) ,两眼瞳孔平均直径之差为 0 .2 7mm± 0 .2 1mm (0 .0 36mm～ 0 88mm)。而对于 4 0名不同时间接受 2次检查者 ,第 1次检查时 ,右眼平均瞳孔直径为 6 .93mm± 1.0 5mm(4.85～ 8 81mm) ,第 2次检查时 ,平均直径为 6 .93mm± 0 .93mm (4 87～ 8 89mm) ;第 1次检查时的左眼瞳孔平均直径为 7 0 2mm± 0 .99mm(4 87～ 9.0 5mm) ,第 2次检查时的平均直径为 7.0 5mm± 0 .94mm(4.99～ 9.13mm) ,对于任何一只眼 ,前后 2次的检查结果比较无显著统计学差异 (P <0 0 5 )。结论　红外线瞳孔测试仪可用于定量检查暗环境下的瞳孔大小 ,其可重复性好 ,特别对于屈光手术前瞳孔的检查有着重要的意义。     

单眼挫伤瞳孔对光反射与视功能改变的相关研究

目的：测量单眼挫伤患者瞳孔对光反射的改变，分析瞳孔对光反射与眼挫伤后其他视功能评价方法的相关性。方法：使用红外线自动瞳孔仪分别检测26例单眼挫伤患者双眼瞳孔对光反射，并行视力、视野、图形视觉诱发电位等视功能检查。检查的瞳孔对光反射参数包括瞳孔面积，对光反应潜伏期、反应幅度。结果：眼挫伤患者健眼直接、间接反应幅度比与双眼视力差具有显著相关性（r=-0．648）；瞳孔对光反应幅度差、反应幅度比均与视野平均偏差具有显著相关性（r=0．5和r-0．535）；瞳孔对光反应幅度比与双眼视觉诱发电位振幅比具有显著相关性；多重线性回归分析显示瞳孔对光反应幅度和VEP振幅结合可提高预测视力预后的可能性。结论：在瞳孔对光反射各参数中，瞳孔对光反应幅度在反映眼挫伤后视功能改变方面优于其它参数，眼挫伤患者瞳孔对光反应幅度与视力、视野、VEP波幅具有中度相关性，其与VEP联合应用可提高眼挫伤后准确预测视功能的可能性。     

近视患者瞳孔大小变化的研究

目的测量我国青年近视眼患者及正常青年在暗适应条件下的瞳孔大小,并探讨其异同。方法用红外线瞳孔测试仪测量150例近视眼患者(300眼,低、中、高度近视眼各100眼)及50例正常人(100眼)在暗适应条件下的瞳孔大小。检测对象年龄24.0岁±3.6岁(20～30岁),所有测试者在暗适应5分钟后由同一检查者进行检查,重复检查3次,各次检查间隔至少15分钟。取3次检查结果的平均值,分析所得数据。结果正常人瞳孔面积为(30.21±6.29)mm2,近视眼瞳孔面积(39.30±9.24)mm2;低、中、高度近视眼瞳孔面积分别为(33.65±7.31)mm2、(38.74±7.37)mm2、(45.61±9.08)mm2。统计分析显示,正常人与近视眼患者的瞳孔大小有显著统计学差异(P<0.01),正常人与低、中、高度近视眼患者的瞳孔大小均有统计学差异(P<0.01),低、中、高度近视眼患者间的瞳孔大小也有统计学差异(P<0.01)。结论青年近视眼患者的瞳孔比正常青年的瞳孔大,人的瞳孔面积随着近视度数的加深而增大。这对我们进一步认清近视发生发展的过程及其机理有一定的意义,对临床屈光手术前瞳孔的检查、手术面积的确定有一定的指导意义。     

Oculus角膜地形图仪在测量瞳孔直径及对光反射评估中的应用

目的 评价Oculus角膜地形图仪在测量不同光照强度下瞳孔直径及瞳孔对光反射的应用价值及测量的可重复性.方法 横断面研究.采用Oculus角膜地形图仪观察125例(125眼)患者不同光照刺激下(无光刺激,短光刺激及长光刺激模式)的瞳孔直径及对光反射,记录各瞳孔参数.分别采用独立样本t检验和单因素方差分析验证不同性别组与不同屈光度组的瞳孔参数的差异;配对t检验分析患者长光刺激模式刺激后1 s与5 s瞳孔直径差异.以组内相关系数(ICC)及Bland-Altman分布作为评判重复性、再现性的指标.结果 3种测量模式下最大瞳孔直径差异无统计学意义(F=1.03,P＞0.05);无光刺激模式中最小瞳孔直径,最大瞳孔直径及直径极差分别为(5.34±0.95)mm,(6.18±0.85)mm及(0.86±0.37)mm.短光刺激模式中最小、最大瞳孔直径,直径极差,光刺激后1 s瞳孔直径分别为(3.57±0.74)mm,(6.10±0.92)rmm,(2.54±0.40)mm和(2.34±0.46) mm.长光刺激模式中最小、最大瞳孔直径,直径极差,光刺激开始1 s后及5 s后的瞳孔直径分别为(2.69±0.45) mm,(5.94±0.84)mm,(3.27±0.55)mm,(2.72±0.58)mm和(2.94±0.47) mm.长光刺激模式中光刺激后1 s与5 s瞳孔直径差异有统计学意义(t=0.38,P＜0.01).各瞳孔参数的ICC均大于0.800; Bland-Altman分布显示的一致性范围均小于或接近1.0 mm.不同屈光度组及不同性别各瞳孔参数差异无统计学意义.结论 Oculus角膜地形图仪能测量不同光照度下的瞳孔直径,并可用于评估瞳孔对光反射.其测量结果有较好的可重复性和一致性.     

相对性传入性瞳孔障碍（RAPD）

光线射眼时引起瞳孔缩小,称光反射。分直接、间接光反射两种。以光照射一眼,引起被照射眼瞳孔缩小称直接光反射。光照射一眼,引起另眼瞳孔同时缩小称间接光反射。瞳孔光反射异常可分为传出性瞳孔障碍和传人性瞳孔障碍,可通过双眼的直接、     

相对性瞳孔传入障碍的临床检查及意义

传入性瞳孔障碍是指位于视网膜、视神经、视交叉、视束或中脑顶盖前区的病变，例如视网膜脱离、视神经炎、压迫性视神经病变等，使光刺激信号传入受阻，不能正常传至瞳孔运动中枢，导致瞳孔对光反应下降。若仅一眼存在传入性瞳孔障碍而另眼正常，或两眼传入性瞳孔障碍程度不对称，称为相对性瞳孔     

相对性瞳孔传入障碍检查在神经眼科中的应用

瞳孔对光反射是神经眼科重要的一项观察指标,反映了视觉系统神经元的信息输入和传出反射弧的完整性。视觉输入系统任何一个部位病变都可能导致瞳孔对光反应下降,表现为瞳孔传人障碍。由于双眼光线传人强度的不对称所致的瞳孔传入障碍称为相对性瞳孔传人障碍（RAPD）。检测RAPD是非常重要、可信、灵敏的神经眼科检查方法。如果检测方法正确,RAPD这一体征将对许多眼科疾病的诊断和预后评估具有特殊价值。本文就其检测方法和结果分析等相关内容作一介绍。     

研究弱视眼瞳孔直径变化探讨其视觉通路的功能

目的 比较弱视儿童的弱视眼与对侧健眼的瞳孔直径在不同光照条件下的变化差异,分析其视觉通路功能与对侧健眼的差异.方法 随机选择30例单眼弱视儿童,包括屈光参差性弱视17例、屈光不正性弱视8例以及斜视性弱视5例,其中中度弱视13例,轻度弱视17例.所有患者弱视眼矫正视力0.2～0.8,所有患者对侧健眼矫正视力0.9～1.2.应用照相机拍摄法在普通光照条件、直接对光条件、间接对光条件及夜间环境条件下,让受试者分别注视远距和近距E视标,来测量弱视眼与对侧健眼的瞳孔直径,比较其差异.结果在四种不同光照条件下,受试者在注视远距及近距E视标时,其弱视眼组的瞳孔直径均大于对侧健眼组(P<0.05),弱视眼在看远看近两种状态下,直接对光反射时的瞳孔直径均大于间接对光反射时的瞳孔直径;弱视眼在间接对光反射时的瞳孔直径均大于健眼直接对光反射时的瞳孔直径;弱视眼直接对光反射时的瞳孔直径均大于健眼间接对光反射时的瞳孔直径,差异均有统计学意义(P<0.05).结论 弱视眼视网膜功能较对侧健眼要降低,弱视眼的近反射中枢(枕叶视皮质)功能可能较对侧健眼下降,并且E-W核功能下降是弱视眼瞳孔直径异于对侧健眼的主要原因,从而推断弱视在发生发展的过程中,弱视眼的视网膜、视觉传导通路及视皮层均存在损害.     

The pupillary light reflex in normal subjects.

In 19 normal subjects the pupillary reflex to light was studied over a range of stimulus intensities by infrared electronic pupillography and analysed by a computer technique. Increasing stimulus intensity was associated with an increase in direct light reflex amplitude and maximum rate of constriction and redilatation. Latency from stimulus to onset of response-decreased with increasing stimulus intensity. The normal range for each of these parameters is given and the significance of these results in clinical pupillary assessment discussed.     

Consensual pupillary light response in the red-eared slider turtle (Trachemys scripta elegans)

Purpose of this study was to determine if the turtle has a consensual pupillary light response (cPLR), and if so, to compare it to its direct pupillary light response (dPLR). One eye was illuminated with different intensities of light over a four log range while keeping the other eye in darkness. In the eye directly illuminated, pupil diameter was reduced by as much as ∼31%. In the eye not stimulated by light, pupil diameter was also reduced but less to ∼11%. When compared to the directly illuminated eye, this generated a ratio, cPLR-dPLR, equal to 0.35. Ratio of slopes for log/linear fits to plots of pupil changes versus retinal irradiance for non-illuminated (−1.27) to illuminated (−3.94) eyes closely matched at 0.32. cPLR had time constants ranging from 0.60 to 1.20 min; however, they were comparable and not statistically different from those of the dPLR, which ranged from 1.41 to 2.00 min. Application of mydriatic drugs to the directly illuminated eye also supported presence of a cPLR. Drugs reduced pupil constriction by ∼9% for the dPLR and slowed its time constant to 9.58 min while simultaneous enhancing constriction by ∼6% for the cPLR. Time constant for the cPLR at 1.75 min, however, was not changed. Results support that turtle possesses a cPLR although less strong than its dPLR.     

我国正常人多焦视网膜电图的特征

目的　检测我国正常人多焦视网膜电图（electroretinogram,ERG）的特征,以探讨其正常参考值。方法　应用VERIS4.0视诱发反应图像系统检测42例(48只眼)正常人多焦ERG,检测对象年龄11～67岁,平均40.7岁。检测视野的水平视角为±26.6°,垂直视角为±22.1°,采用Burian-Allen接触镜电极,于8min(分16段)记录103个视网膜部位的反应。结果　随被检测者年龄增长,多焦ERG的N1波和P1波潜伏期延长,<50岁与≥50岁年龄组间比较差异有显著性(t值均>2.01,P值均<0.05);N1波和P1波振幅密度降低,个体间变异较大,在中央凹N1波和P1波的振幅密度最大,分别为(44.88±13.30)nV/deg     

The pupillary light reflex in migraine

The literature suggests that there may be pupil size and response abnormalities in migraine headache sufferers. We used an infra-red pupillometer to measure dynamic pupil responses to light in 20 migraine sufferers (during non-headache periods) and 16 non-migraine age and gender matched controls. There was a significant increase in the absolute inter-ocular difference of the latency of the pupil light response in the migraine group compared with the controls (0.062 s vs 0.025 s, p = 0.014). There was also a significant correlation between anisocoria and lateralisation of headache such that migraine sufferers with a habitual head pain side have more anisocoria (r = 0.59, p < 0.01), but this was not related to headache laterality. The pupil changes were not correlated with the interval since the last migraine headache, the severity of migraine headache or the number of migraine headaches per annum. We conclude that subtle sympathetic and parasympathetic pupil abnormalities persist in the inter-ictal phase of migraine.     

Relative afferent pupillary defect with normal vision and vertical strabismus—implications for pupillary pathway anatomy

Background A relative afferent pupillary defect (RAPD) is usually a sign of visual dysfunction. Here, an unusual case of an RAPD combined with vertical strabismus but normal vision is described. Implications for pupillary pathway anatomy are discussed. Methods A 12-year-old girl with chronic headache was shown to have a midbrain tumour. She presented to us with intermittent diplopia. Examination included visual acuity, visual fields, pupillary function, anterior and posterior segments, and strabismus evaluation with the tangent screen. Results There was a right-sided pathologic RAPD but no afferent visual impairment. Isocoria was present in light and darkness. There was a right-sided strabismus sursoadductorius. Conclusions A pathologic RAPD with normal vision can be caused by tumour compression of the contralateral pretectal nucleus or its afferent or efferent fibres. As an implication for pupillary pathway anatomy, our case suggests that there is equal distribution between crossing and non-crossing intercalated neurons. An associated strabismus can show a non-paralytic pattern.     

The pupillary light reflex. 1. Age-dependent and age-independent parameters in normal subjects.

A hundred and three normal subjects (14-75 years old) were examined with a modified infrared TV videopupillometer that had previously been developed. Maximal pupillary diameter (p less than 0.00001), pupillary diameter in percent of iris diameter (p less than 0.00001), maximal pupillary area (p less than 0.00001), latency time of the light reflex (p less than 0.00001), maximal contraction velocity (p less than 0.00002), contraction velocity at 1 s (p less than 0.00001) and dilatation velocity at 6 s (p less than 0.0001) are strongly age dependent. A statistical formula is given to allow the calculation of the exact percentile for every parameter. Parameters which are age independent if they are expressed in percent of the maximal pupillary area are contraction velocity at 1 s (r = 0.042, p = 0.68) and dilatation velocity at 6 s (r = -0.150, p = 0.13). They can be used if age-matched study groups are not available. Furthermore, it is shown that most parameters of the pupillary light reflex correlate significantly with each other. The highest correlations are found with the maximal pupillary area. Differences between sexes are not evident. It is thought that this infrared videopupillometry and the given data base are useful for further clinical studies to investigate the autonomic nervous system.     

Operational implications of varying ambient light levels and time-of-day effects on saccadic velocity and pupillary light reflex

Changes in maximal saccadic velocity (SV), initial pupil diameter (IPD), constriction latency (CL) and constriction amplitude (CA) determined by the pupillary light reflex have been found to be sensitive indicators of impairment as a result of drugs, sleepiness, and/or fatigue. Ambient illuminance and time of day are controlled when these indices are applied as repeated measures in fitness-for-duty determinations. The application of oculometrics in unrestricted operational environments, where ambient illuminance and time-of-day testing are not constant, requires understanding of, and potential compensation for, the effects of, and interactions among, these multiple uncontrolled variables. SV, IPD, CL, and CA were evaluated in the morning and evening on two consecutive days following adequate nightly sleep under one baseline ambient illuminance and seven test ambient illuminances. Sixteen healthy volunteers (21-38 years, eight females/eight males) participated. Within and across days, SV was unaffected by decreasing ambient light or time-of-day effects. With the increase of ambient light from 670 to 3300 lx, CL decreased by 1%, while IPD and CA decreased by 17% and 20%, respectively. IPD increased with time of day by 1-10% (IPD was smaller in the morning). The results show that SV and CL are essentially resistant to changes in ambient light and time-of-day effects, simplifying their application in uncontrolled operational environments.