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。     

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,...     

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.     

原发性开角型青光眼患者视野缺损和瞳孔的关系

目的：测量原发性开角型青光眼患者的瞳孔对光反射,探索青光眼患者视野缺损和瞳孔的关系。方法：连续选取2014－07／2015－10于我院就诊的原发性开角型青光眼患者86例115眼和健康个体16例23眼纳入本研究,所有受试者均接受全面的眼科检查、视野检查（ Humphrey , SITA Standard 24－2）和动态瞳孔测量（ MonCV3 Metrovision ）。依据视野检查结果和青光眼分期系统,将青光眼患者分为5个亚组,即1期亚组、2期亚组、3期亚组、4期亚组和5期亚组。瞳孔对光反射相关的测量指标包括：瞳孔直径（最小和最大瞳孔直径）、收缩和开大的潜伏时间、收缩和开大的持续时间、收缩和开大的速度、收缩幅度以及瞳孔收缩比例。使用SPSS 19．0统计软件包对测量结果进行统计分析。结果：青光眼组中4期亚组和5期亚组的最小瞳孔直径与对照组差异有统计学意义（P＝0．032,P＝0．014）;各组的瞳孔收缩速度相比,差异有统计学意义（ F＝648．675, P＜0．01）,其中5期亚组的瞳孔收缩速度小于其他亚组和对照组（P＜0．05）;3期、4期和5期亚组的瞳孔收缩比例与对照组差异有统计学意义（ P＜0．05）;瞳孔收缩速度、瞳孔收缩比例和最小瞳孔直径与青光眼的视野分期相关。结论：原发性开角型青光眼患者的瞳孔瞳孔收缩能力有所下降,瞳孔收缩能力的下降与视野缺损程度相关。     

瞳孔检查的临床应用

以计算机为基础的红外线视频系统使瞳孔检查进入了新的临床应用时代。临床医生进行瞳孔检查时，开始对瞳孔对光反射进行分级。于是，瞳孔检查开始应用于眼科以下领域：为屈光手术测量瞳孔大小、区别Horner综合症和生理性瞳孔不等大、定量相对性瞳孔传入障碍和描绘视野等。此外，瞳孔检查还被应用于睡眠、新药物的自主神经效果观察等方面。     

海德堡视网膜断层扫描仪测量黄斑厚度的 可重复性研究

目的对海德堡视网膜断层扫描仪（HRT）黄斑水肿分析软件（MEM）进行黄斑厚度测量的可重复性评价。方法对62名正常人（9～68岁）用HRT-Ⅱ黄斑程序进行检查，对黄斑部视网膜信号宽度、中心凹视网膜信号宽度和黄斑水肿指数进行均数分析、t 检验和相关分析，对个体内重复测量的变异性采用变异系数、95%耐受限（TC）、类内相关系数（ICC）进行研究。结果正常人的黄斑部视网膜信号宽度为（0.734±0.236） mm，中心凹视网膜信号宽度为（0.781±0.243）mm，平均水肿指数E=（1.169±0.619）。各参数的重复测量变异系数分别为：视网膜信号宽度（8.7±6.8）%，中心凹视网膜信号宽度（8.5±6.7）%, 平均水肿指数（15.6±13.9）%；个体内连续重复测量发生改变的95%TC分别为，视网膜信号宽度0.131（8.9%）；中心凹信号宽度0.137（10.5%）；平均水肿指数0.198（7.4%）。同一操作者对同一个体进行多次重复测量的ICC分别为：黄斑区视网膜信号宽度0.950；中心凹信号宽度0.949；平均水肿指数0.898。结论海德堡视网膜断层扫描仪MEM软件，具有无创、快速、可重复性较好等特点，为视网膜厚度相关的黄斑疾病的客观定量监测提供了一种新的手段。(中华眼底病杂志,2005,21:103-105)     

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）     

趋势导向视野检查与常规阈值视野检查的比较研究

目的比较趋势导向视野检查程序(Tendency Oriented Peri metrey,TOP)与常规视野检查程序对青光眼病人视野检查结果的差异,对IOP程序检查结果进行评价。方法用Ocutopus101电脑视野计对36例青光眼患者共46眼分别用常规阈值程序(Normal/Normal)和趋势导向(TOP)视野检查程序进行检查。将两种方法的视野检查结果进行分析比较。结果①36例青光眼患者共46眼,常规阈值程序检查均有视野损害,其中早期青光眼15眼,中晚期31眼。早期患者用TOP程序检查的阳性率为73%(11/15),中晚期患者TOP程序均能够发现视野损害,视野损害的部位两种程序有较高的一致性。②视野指数的比较,青光眼患者TOP程序和Normal程序检查MS分别为15.78±4.81,13.33±4.24,P=0.008;MD分别为13.36±4.89,14.31±4.18,P=0.02;LV分别为65.40±37.55,50.77±34.24,P<0.001;两种程序检查RF值均小于15%。③两种检查方法所费时间,TOP程序为4.10±0.59分Normal程序为11.01±3.15分。结论①TOP视野检查程序可大大地缩短检查时间,可用于大规模人群的筛查,但是TOP视野检查程序对早期青光眼检测敏感性偏低,仅为73%。②对中晚期病例,TOP程序与Normal程序相比较,MS高于正常阈值程序检查的结果,MD和LV低于正常阈值程序检查结果,也就是TOP视野检查程序的发现的视野缺损较小,暗点更浅。     

SD-OCT自动化分割算法分析黄斑区神经节细胞复合体的可重复性研究

目的:应用频域光相干断层扫描仪(SD-OCT)对正常受试者黄斑区神经节细胞复合体进行测量,评估其可重复性.方法:采用横断面研究设计,纳入正常受试者43例86眼,用Cirrus HD-OCT扫描受试者双眼以黄斑中心凹为中心6mm×6mm扫描区的视网膜各层厚度图像,采用神经节细胞复合体自动分割算法(ganglion cell analysis,GCA)分析软件对黄斑区神经节细胞内丛状层(GCIPL)进行分析.测量指标 GCA算法GCIPL厚度识别范围是GCL的最内层到IPL的最外层.测量指标包括:平均厚度、最小厚度、椭圆分区2:00、4:00、6:00、8:00、10:00和12:00区域.每个受检眼先由A操作者连续拍摄2次,然后由B操作者拍摄2次,后两次扫描均采用随访模式,计算出受试者内部标准差(SD)、变异系数(CV)和同类相关系数(ICC)以评价该仪器测量的可重复性.结果:右眼黄斑区GCIPL平均厚度为85.12±3.95μm,最小平均厚度为83.21±4.41μm,SD范围3.79~4.84μm,CV:95%CI 0.26~0.93,ICC为0.939~0.989.左眼黄斑区GCIPL平均厚度为84.65±8.73μm,最小平均厚度为81±13.08μm,SD范围8.24~10.56μm,CV:95%CI 0.92~4.94,ICC为0.264~0.968.结论:Cirrus HD-OCT GCA是一种非常可靠的工具,可提供重复性的GCIPL厚度计算,在视网膜疾病的监测和随访上有很大的临床应用潜力.     

OCT不同扫描模式检测视网膜神经纤维层厚度的可重复性研究

目的 采用光学相干断层成像扫描(optical coherence tomography,OCT)不同扫描模式检测视网膜神经纤维层(retinal nerve fiber layer,RNFL)厚度的可重复性.方法 采用双盲法,2名检查者对20名(20眼)正常人分别以OCT 3种不同扫描模式:RNFL厚度(3.4)扫描模式,视神经盘圆(0.98 视盘半径)扫描模式,RNFL厚度(2.27×disc)扫描模式,连续3 d测量RNFL厚度,每天每眼记录5幅图像,取其中3幅图像的RNFL厚度值的平均值.计算3 d中全周平均及各象限RNFL厚度的变异系数.比较3种扫描模式检测RNFL的可重复性.结果 OCT 3种扫描模式所测全周平均及4象限RNFL厚度的变异系数范围分别是:RNFL厚度(3.4)扫描模式:(4.57±2.14)%～(9.57±6.28)%,视神经盘圆(0.98 视盘半径)扫描模式:(1.14±0.59)%～(4.81±2.22)%,RNFL厚度(2.27×disc)扫描模式:(2.77±1.49)%～(9.52±4.50)%,且均以鼻侧象限最大.2名操作者间变异系数对比差异无统计学意义(P＞0.05).结论 OCT 3种扫描模式检测RNFL可重复性均较好.以视神经盘圆(0.98 视盘半径)扫描模式最优.3种扫描模式检测各象限RNFL均以鼻侧象限的可重复性最差.     

Agreement and repeatability of pupillometry using videokeratography and infrared devices

PURPOSE: To evaluate the accuracy and repeatability of the pupil-measuring modules of several corneal topography devices. SETTING: Department of Ophthalmology, Saint Louis University Eye Institute, St. Louis, Missouri, USA. METHODS: In 14 eyes of 7 healthy myopic patients, pupillometry was performed with 3 corneal topography devices and with an infrared pupillometer under luminance-matched conditions for the Placido projection of the topography devices. Pupils were also measured under a mesopic condition. Outcomes were pupil diameters, limits of agreement, and coefficient of repeatability of the topography devices. RESULTS: Mean pupil diameter measurements with the Technomed C-Scan, Humphrey Masterview, Alcon EyeMap, and under a mesopic condition were 3.35 mm, 2.96 mm, 2.34 mm, and 5.94 mm, respectively. All pupil diameter measurements differed significantly from one another except those by the Masterview and C-Scan devices. The mean difference between the C-Scan and luminance-matched infrared measurements was 0.74 mm and between the Masterview and luminance-matched infrared measurements, 0.27 mm. The limits of agreement +/- 2 standard deviations was 4.12 mm and 1.56 mm for the C-Scan and Masterview devices, respectively. Coefficients of repeatability were 0.56 mm, 0.46 mm, and 0.44 mm for the C-Scan, Masterview, and EyeMap devices, respectively. CONCLUSIONS: Although topography pupillometry was repeatable, it underestimated the largest natural pupil diameter because of the luminance of the Placido rings. The difference in limits of agreement between the C-Scan and Masterview devices may be explained by pupil physiology and the static nature of videokeratoscopy. These results have implications when topography pupillometry is used to assess pupil diameters prior to refractive surgery. We do not recommend using pupil diameters measured by topography to preoperatively determine halo-related safety.     

Agreement and repeatability of infrared pupillometry and the comparison method

ObjectiveTo evaluate the accuracy and repeatability of the widely used comparison method of measuring pupil size.DesignCross-sectional study.ParticipantsFourteen eyes of seven healthy myopic subjects were examined.InterventionTwo examiners made two repeated measures of pupil diameters of 14 eyes using Rosenbaum card comparison pupillometry and infrared pupillometry. Subjects fixated on a distant visual acuity chart, and pupils were measured under three luminance conditions. The agreement and inter-rater repeatability of both methods were determined.Main outcome measuresOutcomes were pupil diameters, limits of agreement, and coefficient of repeatability of two examiners.ResultsThe mean difference between the two techniques ranged from 0.3 to 0.5 mm. The limits of agreement within two standard deviations ranged from 2.4 to 2.8 mm. Coefficient of repeatability ranged from 0.6 to 1.4 mm for infrared pupillometry and 1.0 to 1.2 mm for Rosenbaum pupillometry. Inter-rater repeatability of Rosenbaum pupillometry was consistently pupil diameter biased. Pupil diameters measured with the Rosenbaum method were consistently larger than diameters measured with the infrared technique for both examiners under all luminance conditions.ConclusionsResults indicate that although the mean difference in techniques was small, the range of the agreement between the Rosenbaum and the infrared techniques was large. The Rosenbaum method consistently overestimated pupil diameters and was subject to inter-rater repeatability bias. Rosenbaum pupillometry may not be appropriate when accurate pupil measurements are required. The results have implications for many clinical trials in ophthalmology, including those evaluating refractive surgery that use Rosenbaum comparison pupillometry.     

Explanation of Broca's pupillometer

Broca's pupillometer offers a simple and effective means of measuring the diameter of the pupil. However, it is often used without proper attention to the limitations of its optics. Errors of measurement may result from uncorrected refractive error, accommodation, spectacle correction, and spherical aberration (SA). A simple means of minimizing these errors is to hold the pinholes (PH's) of the pupillometer as close to the cornea as is feasible.     

Assessment of pupil size under different light intensities using the Procyon pupillometer

PURPOSE: To study the relationship between pupil size and light intensity using the Procyon pupillometer. SETTING: University based clinic. METHODS: In this retrospective study, 20 consecutive patients had pupil size assessment with the Procyon pupillometer under 3 different light conditions--4, 0.4, and 0.04 lux. Correlation was established using the log unit of the light intensity and pupil size. RESULTS: The correlation coefficient for the association between pupil size and log unit of light intensity in all eyes was significant (P<.001). The mean correlation coefficient for the association between pupil size and log unit of light intensity in all patients was 0.968 +/- 0.089 (SD) in the right eye and 0.970 +/- 0.031 in the left eye. CONCLUSION: The linear relationship between the pupil size and the log unit of the light intensity showed a tight correlation in all cases. These results can be useful in the comparing pupil size with pupillometers that work under different light conditions.     

Evaluation of the pinhole pupillometer

Evaluation of pupil diameter is used in many clinical and research fields to aid diagnosis of neurological disorders and to monitor pharmacological effects upon the eye. Methods used to determine pupillary diameter have evolved from simple scale measurements to much more complex systems, supposedly improving accuracy and repeatability. However, many techniques are restricted to the consulting room or research laboratory due to the size of the equipment, its cost, or the expertise required. We have evaluated a portable pupillometer originally developed by Broca, capable of precise measurements on fixed, dilated pupils, that has the potential to be used by unsupervised patients. Luminance levels will still need to be controlled because, although luminance does not influence the mechanics of the pupillometer itself, it significantly affects the natural pupil. The pinhole size should ideally be 1.1 mm in diameter, since smaller pinholes underestimate and larger holes overestimate pupil size. The pupillometer also exhibited reasonable accuracy in fixed pupils dilated with tropicamide. Pupil measurements were overestimated by 0.5% using the 1.1 mm pinholes (insignificant if the pupil can be measured to the nearest 0.25 mm) and both intra- and inter-visit repeatabilities were relatively good. The results from this study therefore indicate that the pinhole pupillometer may be of use in pupil research, since it facilitates more frequent pupillary measurements over much longer time intervals than are currently achievable.     

Scotopic pupil size in a normal pediatric population using infrared pupillometry

Purpose To determine scotopic pupil diameter in a normal pediatric population.Methods Scotopic pupil size was measured in 166 eyes of 83 children with a mean age of 6.01±4.11 years (range 0.51–14.26 years) using the light and hand-held Colvard infrared pupillometer. Measurements were performed under dim illumination after 2 min of dark adaptation. The Colvard infrared pupillometer utilizes light amplification technology to determine scotopic pupil size.Results The mean scotopic pupil diameter was 6.06±0.95 mm (range 4.0–8.5 mm) in the right eyes (OD) and 6.11±1.02 mm (range 4.0–8.5 mm) in the left eyes (OS), and 6.09±0.98 mm (range 4.0–8.5 mm) for both eyes (OU). An increase in mean scotopic pupil size with age was detected, with a peak of 7.28±0.42 mm at the age of 10–11 years. The correlation coefficient for age and scotopic pupil diameter was 0.51 OU (OD 0.52, OS 0.51), and the correlation coefficient for objective refraction (spherical equivalent) and scotopic pupil diameter was 0.05 OU (OD 0.01, OS 0.08).Conclusions The scotopic pupil diameter in a pediatric population increases with age until the age of 11 years and then decreases again.Presented in part at the American Society of Cataract and Refractive Surgeons (ASCRS), Boston, USA, May 2000 and the Deutsche Ophthalmologische Gesellschaft (DOG), Berlin, Germany, September 2000The authors have no proprietary interest in any of the devices used in this study