彩色光瞳孔测量法评估视网膜色素变性盲人视功能的临床意义  

Clinical significance of chromatic pupillometry in evaluating visual function in blind patients with retinitis pigmentosa

作　　者：赵赫 王浩 翁传煌 刘勇 阴正勤 ZHAO He;WANG Hao;WENG Chuanhuang;LIU Yong;YIN Zhengqin(Department of Ophthalmology,First Affiliated Hospital,Army Medical University(Third Military Medical University),Chongqing,400038,China)

机构地区：[1]陆军军医大学(第三军医大学)第一附属医院眼科,重庆400038

出　　处：《陆军军医大学学报》2023年第21期2284-2292,共9页Journal of Army Medical University

基　　金：国家自然科学基金面上项目(81770972,81970843)。

摘　　要：目的研究彩色光瞳孔测量法量化评估视网膜色素变性(retinitis pigmentosa,RP)盲人视网膜功能的可行性和有效性。方法纳入2022年1-12月在本院眼科就诊并达到法律盲标准的RP盲人46例(81眼),并根据最佳矫正视力分为无形觉组(no form perception,NFP)、微弱形觉组(faint form perception,FFP)、形觉组(form perception,FP)。另招募18名健康志愿者(18只眼)作为对照。入组病例接受彩色眼底照相、光学相干断层扫描、眼底自发荧光和闪光视觉诱发电位(flash visual evoked potential,FVEP)等眼科常规检查,并收集OCT外核层厚度、FAF高荧光区垂径长度、FVEP P2波幅值。而后行彩色光瞳孔测量检查,光刺激模式为可激活视杆细胞的低强度蓝光、激活视锥细胞的高强度红光,评价指标为瞳孔瞬时收缩幅值(transient pupil construction amplitude,TPCA)、收缩潜时、最大收缩速度(maximal contraction velocity,MCV)和收缩时间。结果在低强度蓝光刺激下,超过半数RP盲人视杆细胞瞳孔对光反应消失。在高强度红光刺激下,RP盲人视锥细胞瞳孔对光反应大部分保留且明显降低。各RP盲人组视锥细胞瞳孔反应的TPCA、MCV均较对照组有显著降低(P<0.05),收缩潜时较对照组显著升高(P<0.05)。NFP组瞳孔TPCA、MCV较FP组显著降低(P<0.05),收缩潜时较FP组显著升高(P<0.05)。视锥细胞瞳孔反应的TPCA、MCV分别与视网膜外核层厚度、自发荧光垂径和FVEP P2波幅值呈显著正相关(P<0.05),收缩潜时与视网膜外核层厚度、FVEP P2波幅值呈显著负相关(P<0.05)。结论彩色瞳孔测量法能够定量区分有形觉视力和无形觉视力的RP盲人视网膜功能差异;彩色光瞳孔测量结果改变与病变视网膜形态学和功能学的变化一致。Objective To study the feasibility and effectiveness of quantitative evaluation of retinal function in blind patients with retinitis pigmentosa(RP)by chromatic pupillometry.Methods A total of 46 blind RP patients(81 eyes)who met the legal blindness standard admitted in our department from January 2022 to December 2022 were recruited in this study.According to their best-corrected visual acuity,they were divided into the no form perception(NFP)group,faint form perception(FFP)group,and form perception(FP)group.Another 18 healthy volunteers(18 eyes)were enrolled as controls.The subjects received routine ophthalmic examinations such as color fundus photography,optical coherence tomography(OCT),fundus autofluorescence(FAF),and flash visual evoked potential(FVEP).The thickness of the outer nuclear layer of OCT,vertical diameter of the FAF high fluorescence area,and amplitude of FVEP P2 were collected.Then chromatic pupillometry was performed.The light stimulation mode of low-intensity blue light was conducted to activate rods,and of high-intensity red light to activate cones.The evaluation indexes included transient pupil construction amplitude(TPCA),latency,maximal contraction velocity(MCV),and contraction duration.Results Under the mode of low-intensity blue light stimulation,more than half of the blind RP patients had rods pupil light reaction disappeared.Under the mode of high-intensity red light stimulation,the blind RP patients though retained pupil response of cone cells to light mostly but the response was significantly weakened.Compared with the control group,the TPCA and MCV of the cones’pupillary responses were significantly lower(P<0.05),and the contraction latency was obviously higher(P<0.05)in all RP blind groups.The NFP group had significantly lower TPCA and MCV and higher contraction latency when compared with the FP group(both P<0.05).Positively correlations were observed in the TPCA and MCV of the cones’pupillary responses with the thickness of the outer nuclear layer of the retina,the vertical di

关 键 词：瞳孔光反射 法律定义盲人 功能学检测 

分 类 号：R181.32[医药卫生—流行病学] R770.425[医药卫生—公共卫生与预防医学] R774.13