相对传入性瞳孔障碍在双眼非对称性白内障中的表现
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摘要
目的探讨双眼非对称性白内障中,较好眼相对传入性瞳孔障碍(RAPD)的发生率、相关因素及预后意义。方法应用交替光照检查法和瞳孔及眼动功能数字化检测仪分别检测80例双眼不对称性白内障患者的瞳孔对光反射情况,平均年龄71. 8±8. 5(50～88)岁,其中男性40例,女性40例。结果所有受试者中,较好眼发生RAPD的有48例(60%),经手术后,较好眼RAPD消失或转移到对侧眼。RAPD组与非RAPD(NRAPD)组的双眼视力差无统计学差异,术前RAPD与术后视力情况无明显相关性。结论瞳孔测试仪对于诊断RAPD具有较高的灵敏度和特异性,其中,收缩幅度和收缩速度较收缩反应潜伏期相比,具有更好的灵敏度和特异度。非对称性白内障患者中,超过半数患者较好眼存在RAPD,在行白内障超声乳化吸除联合人工晶状体置入术后,较好眼的RAPD消失。术前RAPD的发生率与术后视力的预后不相关。
Objective To investigate the incidence,associated factors,and prognostic signicance of relative afferent pupillary defects( RAPD) in eyes with less severe cataract than that in contralateral eyes. Methods Prospective case observational study. 160 eyes of 80 patients with asymmetric cataract were detected,the average age was 71. 8 ± 8. 5( 50 ～88) years,including 40 males and 40 females. Pupillary light reflex was performed in 80 patients with asymmetric cataract using a swinging ashlight test and computerized portable pupillometer before and after cataract surgery. Results 48 out of80 patients( 60%) had RAPD in the eye with less severe cataract. The RAPD was resolved or switched to the contralateral eye after cataract extraction. There is no difference for visual acuity in the eyes of patients between RAPD group and those without RAPD( NRAPD group). There was no correlation between the presence of RAPD and postoperative visual acuity.Conclusions There is high sensitivity and specificity in patients diagnosed with RAPD by using computerized portable pupilometer. The high sensitivity and specificity were achieved on both contraction amplitude and contraction velocity comparing to contraction latency. More than half patients with asymmetric cataract had RAPD that was resolved after cataract emulsification and intraocular lens implantation. There is no correlation between the preoperative RAPD and postoperative visual acuity.
Objective To investigate the incidence,associated factors,and prognostic signicance of relative afferent pupillary defects( RAPD) in eyes with less severe cataract than that in contralateral eyes. Methods Prospective case observational study. 160 eyes of 80 patients with asymmetric cataract were detected,the average age was 71. 8 ± 8. 5( 50 ～88) years,including 40 males and 40 females. Pupillary light reflex was performed in 80 patients with asymmetric cataract using a swinging ashlight test and computerized portable pupillometer before and after cataract surgery. Results 48 out of80 patients( 60%) had RAPD in the eye with less severe cataract. The RAPD was resolved or switched to the contralateral eye after cataract extraction. There is no difference for visual acuity in the eyes of patients between RAPD group and those without RAPD( NRAPD group). There was no correlation between the presence of RAPD and postoperative visual acuity.Conclusions There is high sensitivity and specificity in patients diagnosed with RAPD by using computerized portable pupilometer. The high sensitivity and specificity were achieved on both contraction amplitude and contraction velocity comparing to contraction latency. More than half patients with asymmetric cataract had RAPD that was resolved after cataract emulsification and intraocular lens implantation. There is no correlation between the preoperative RAPD and postoperative visual acuity.
引文
[1]Lam BL,Thompson HS.A unilateral cataract produces a relative afferent pupillary defect in the contralateral eye[J].Ophthalmology,1990,97(3):334-338.
[2]Martinelli P.Holmes-Adie syndrome[J].The Lancet,2000,356(9243):1760-1761.
[3]Broadway,David C.How to test for a relative afferent pupillary defect(RAPD)[J].Community Eye Health Journal,2016,29(96):68-69.
[4]练苹,叶秀兰,顾欣祖,等.相对性瞳孔传入障碍的临床检查及意义[J].中国实用眼科杂志,2003,21(7):481-483.
[5]Hwang JM,Kim C,Kim JY.Relative afferent pupillary defect in patients with asymmetric cataracts[J].J Cataract Refract Surg,2004,30(1):132-136.
[6]Kaeser PF,Kawasaki A.Disorders of pupillary structure and function[J].Neurol Clin,2010,28(3):657-677.
[7]Kawasaki A,Miller NR,Kardon R.Pupillographic investigation of the relative afferent pupillary defect associated with a midbrain lesion[J].Ophthalmology,2010,117(1):175-179.
[8]Tabatabaei SA,Soleimani M,Alizadeh M,et al.Predictive value of visual evoked potentials,relative afferent pupillary defect,and orbital fractures in patients with traumatic optic neuropathy[J].Clin Ophthalmol,2011,5:1021-1026.
[9]张燕,陈洁,吕帆.研究弱视眼瞳孔直径变化探讨其视觉通路的功能[J].中国实用眼科杂志,2009,27(7):739-744.
[10]SkorkovskáK,Wilhelm H,Lüdtke H,et al.Relative afferent pupillary defect in glaucoma[J].Klin Monbl Augenheilkd,2011,228(11):979-983.
[11]Chew SS,Cunnningham WJ,Gamble GD,et al.Retinal nerve fiber layer loss in glaucoma patients with a relative afferent pupillary defect[J].Invest Ophthalmol Vis Sci,2010,51(10):5049-5053.
[12]余芳,顾宝文,李汉珍.相对性瞳孔传入障碍在致盲性眼病检测中的应用[J].国际眼科杂志,2013,13(3):504-506.
[13]Thompson HS,Corbett JJ,Cox TA.How to measure the relative afferent pupillary defect[J].Surv Ophthalmol,1981,26(1):39-42.
[14]Bell RA,Waggoner PM,Boyd WM,et al.Clinical grading of relative afferent pupillary defects[J].Arch Ophthalmol,1993,111(7):938-942.
[15]Wilhelm H.Disorders of the pupil[J].Handb Clin Neurol,2011,102:427-466.
[16]Moeller JJ,Maxner CE.The dilated pupil:an update[J].Curr Neurol Neurosci Rep,2007,7(5):417-422.
[17]Shwe-Tin A,Smith GT,Checketts D,et al.Evaluation and calibration of a binocular infrared pupillometer for measuring relative afferent pupillary defect[J].J Neuroophthalmol,2012,32(2):111-115.
[18]Prakash G,Srivastava D,Suhail M,et al.Assessment of bilateral pupillary centroid characteristics at varying illuminations and post-photopic flash response using an automated pupillometer[J].Clin Exp Optom,2016,99(6):535-543.
[19]Rickmann A,Waizel M,Kazerounian S,et al.Digital pupillometry in normal subjects[J].Neuroophthalmology,2017,41(1):12-18.
[20]Steck RP,Kong M,Mc Cray KL,et al.Physiologic anisocoria under various lighting conditions[J].Clin Ophthalmol,2018,12:85-89.
[21]Ichhpujani P,Rome JE,Jindal A,et al.Comparative study of 3techniques to detect a relative afferent pupillary defect[J].JGlaucoma,2011,20(9):535-539.
[22]Bergamin O,Schoetzau A,Sugimoto K,et al.The influence of iris color on the pupillary light reflex[J].Graefes Arch Clin Exp Ophthalmol,1998,236(8):567-570.
[23]娄华东,徐鑫彦.相对性瞳孔传入障碍及其在眼科的应用[J].临床眼科杂志,2016,24(2):185-188.
[24]Cohen LM,Rosenberg MA,Tanna AP,et al.A Novel computerized portable pupillometer detects and quantifies relative afferent pupillary defects[J].Curr Eye Res,2015,40(11):1120-1127.
[25]Volpe NJ,Plotkin ES,Maguire MG,et al.Portable pupillography of the swinging flashlight test to detect afferent pupillary defects[J].Ophthalmology,2000,107(10):1913-1921.
[26]D.Bollock J.Relative afferent pupillary defect in the better eye[J].J Clin Neuroophthalmol,1990,10(1):45-51.
[27]Sadun AA,Bassi CJ,Lessell S.Why cataracts do not produce afferent pupillary defects[J].Am J Ophthalmol,1990,110(6):712-714.
[2]Martinelli P.Holmes-Adie syndrome[J].The Lancet,2000,356(9243):1760-1761.
[3]Broadway,David C.How to test for a relative afferent pupillary defect(RAPD)[J].Community Eye Health Journal,2016,29(96):68-69.
[4]练苹,叶秀兰,顾欣祖,等.相对性瞳孔传入障碍的临床检查及意义[J].中国实用眼科杂志,2003,21(7):481-483.
[5]Hwang JM,Kim C,Kim JY.Relative afferent pupillary defect in patients with asymmetric cataracts[J].J Cataract Refract Surg,2004,30(1):132-136.
[6]Kaeser PF,Kawasaki A.Disorders of pupillary structure and function[J].Neurol Clin,2010,28(3):657-677.
[7]Kawasaki A,Miller NR,Kardon R.Pupillographic investigation of the relative afferent pupillary defect associated with a midbrain lesion[J].Ophthalmology,2010,117(1):175-179.
[8]Tabatabaei SA,Soleimani M,Alizadeh M,et al.Predictive value of visual evoked potentials,relative afferent pupillary defect,and orbital fractures in patients with traumatic optic neuropathy[J].Clin Ophthalmol,2011,5:1021-1026.
[9]张燕,陈洁,吕帆.研究弱视眼瞳孔直径变化探讨其视觉通路的功能[J].中国实用眼科杂志,2009,27(7):739-744.
[10]SkorkovskáK,Wilhelm H,Lüdtke H,et al.Relative afferent pupillary defect in glaucoma[J].Klin Monbl Augenheilkd,2011,228(11):979-983.
[11]Chew SS,Cunnningham WJ,Gamble GD,et al.Retinal nerve fiber layer loss in glaucoma patients with a relative afferent pupillary defect[J].Invest Ophthalmol Vis Sci,2010,51(10):5049-5053.
[12]余芳,顾宝文,李汉珍.相对性瞳孔传入障碍在致盲性眼病检测中的应用[J].国际眼科杂志,2013,13(3):504-506.
[13]Thompson HS,Corbett JJ,Cox TA.How to measure the relative afferent pupillary defect[J].Surv Ophthalmol,1981,26(1):39-42.
[14]Bell RA,Waggoner PM,Boyd WM,et al.Clinical grading of relative afferent pupillary defects[J].Arch Ophthalmol,1993,111(7):938-942.
[15]Wilhelm H.Disorders of the pupil[J].Handb Clin Neurol,2011,102:427-466.
[16]Moeller JJ,Maxner CE.The dilated pupil:an update[J].Curr Neurol Neurosci Rep,2007,7(5):417-422.
[17]Shwe-Tin A,Smith GT,Checketts D,et al.Evaluation and calibration of a binocular infrared pupillometer for measuring relative afferent pupillary defect[J].J Neuroophthalmol,2012,32(2):111-115.
[18]Prakash G,Srivastava D,Suhail M,et al.Assessment of bilateral pupillary centroid characteristics at varying illuminations and post-photopic flash response using an automated pupillometer[J].Clin Exp Optom,2016,99(6):535-543.
[19]Rickmann A,Waizel M,Kazerounian S,et al.Digital pupillometry in normal subjects[J].Neuroophthalmology,2017,41(1):12-18.
[20]Steck RP,Kong M,Mc Cray KL,et al.Physiologic anisocoria under various lighting conditions[J].Clin Ophthalmol,2018,12:85-89.
[21]Ichhpujani P,Rome JE,Jindal A,et al.Comparative study of 3techniques to detect a relative afferent pupillary defect[J].JGlaucoma,2011,20(9):535-539.
[22]Bergamin O,Schoetzau A,Sugimoto K,et al.The influence of iris color on the pupillary light reflex[J].Graefes Arch Clin Exp Ophthalmol,1998,236(8):567-570.
[23]娄华东,徐鑫彦.相对性瞳孔传入障碍及其在眼科的应用[J].临床眼科杂志,2016,24(2):185-188.
[24]Cohen LM,Rosenberg MA,Tanna AP,et al.A Novel computerized portable pupillometer detects and quantifies relative afferent pupillary defects[J].Curr Eye Res,2015,40(11):1120-1127.
[25]Volpe NJ,Plotkin ES,Maguire MG,et al.Portable pupillography of the swinging flashlight test to detect afferent pupillary defects[J].Ophthalmology,2000,107(10):1913-1921.
[26]D.Bollock J.Relative afferent pupillary defect in the better eye[J].J Clin Neuroophthalmol,1990,10(1):45-51.
[27]Sadun AA,Bassi CJ,Lessell S.Why cataracts do not produce afferent pupillary defects[J].Am J Ophthalmol,1990,110(6):712-714.