定量检测相对性瞳孔传入缺陷在视网膜中央静脉阻塞分型诊断中的意义

目的 探讨相对性瞳孔传入缺陷（ＲＡＰＤ）在视网膜中央静脉阻塞（ＣＲＶＯ）分型诊断中的意义。方法 用中性滤光片定量检测ＲＡＰＤ，分析ＲＡＰＤ与视网膜缺血及视力受损程度的相关性。结果 ３３例单眼ＣＲＶＯ病人，其中１０例缺血型ＣＲＶＯ的ＲＡＰＤ均≥０．９ｌｏｇＵ；２３例非缺血型ＣＲＶＯ中２０例ＲＡＰＤ≤０．３ｌｏｇＵ，无１例大于０．９ｌｏｇＵ。ＲＡＰＤ与视网膜缺血及视力受损程度高度相关。结论 ＲＡＰＤ是早期单眼ＣＲＶＯ分型诊断的敏感指标，０．９ｌｏｇＵ可作为分型诊断的参考“界值”。

Role of relative afferent pupillary defect in differentiating ischemic from nonischemic central retinal vein occlusion

ObjectiveTo determine the role of rela tive afferent pupillary defect (RAPD) in differentiating ischemic from nonischem ic central retinal vein occlusion(CRVO). Methods Eyes with RAPD was first identified by alternating light test, then photographic neutral density filters of known density were placed over the good eye until the two eyes were bala nced.The density of the filter or filters used in combination need to just aboli sh the RAPD was then recorded in log units. Fundus fluorescein angiography was performed to differentiate the two types of CRVO and assess the extent of retin al ischemia. Spearman rank correlation was used to analyze the relationship am ong RAPD,retinal ischemia and visual acuity.ResultsOf 10 patients with unilate ral ischemic CRVO,100% had a RAPD in 0.9 log units or more.In contrast,of 23 patien ts with unilateral nonischemic CRVO,87% had a RAPD of 0.3 log units or less and none had a RAPD larger than 0.9 log units.There was a significant correlation amo ng RAPD,retinal ischemia and visual acuity.Conclusion RAPD is a sensitive indicator in the differential diagnosis of the two types of CRVO, in which 0.9 log units may be considered to be a critical value.