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。

Relation of visual field defect with pupil in patients with primary open angle glaucoma

AIM: To evaluate the pupil light reflex in patients with primary open angle glaucoma, and to investigate the relation between pupil and visual field defect.

METHODS: From July 2014 to October 2015, 115 eyes in 86 patients with primary open angle glaucoma and 23 eyes in 16 healthy individuals were continuously enrolled in this study. All the subjects received comprehensive eye examination, visual field examination(Humphrey, SITA Standard 24-2)and dynamic pupil measurement(MonCV3 Metrovision). According to the visual field and the Glaucoma Staging System, the patients with glaucoma were divided into 5 subgroups: stage 1, stage 2, stage 3, stage 4 and stage 5. The parameters of pupillary light reflex were as follows: pupil diameter(minimum, maximum), latency and duration of contraction, latency and duration of dilatation, contraction amplitude, contraction and dilatation speed, and percent of pupil contraction(PPC). SPSS 19.0 statistical software was used to analyze the measurement results.

RESULTS: The control group significantly differed from the stage 4 subgroup(P=0.032)and stage 5 subgroup(P=0.014)in terms of minimum pupil diameter; there was significant difference in the pupil contraction speed between groups(F=648.675, P<0.01), and the contraction speed in stage 5 subgroup was significantly lower than those in the other subgroups and control group(P<0.05); the control group significantly differed from the stage 3, stage 4, and stage 5 subgroup in terms of PPC(P<0.05). Pupil contraction speed, PPC and minimum diameter showed correlation with the stages of glaucoma.

CONCLUSION: Pupil contraction ability in patients with primary open angle glaucoma was impaired, and the degree of impairment is related with the degree of visual field defect.