Skorkovská Karolína, Wilhelm Helmut, Lüdtke Holger, Wilhelm Barbara
Centre for Ophthalmology, Institute of Ophthalmic Research, University of Tübingen, Tübingen, Germany.
Graefes Arch Clin Exp Ophthalmol. 2009 Jul;247(7):947-53. doi: 10.1007/s00417-009-1040-7. Epub 2009 Feb 19.
The purpose of our study was to demonstrate the ability of pupil campimetry to reproduce visual field defects caused by pre-- and retrogeniculate lesions of the visual pathway.
By means of infrared video pupillography, light responses to perimetric stimuli were recorded. The stimulus pattern consisted of 41 test spots of 4 degrees diameter and 140 cd/m(2) luminance distributed in the central (30 degrees ) visual field. Background luminance was 2.7 cd/m(2). Eight patients with pregeniculate lesions and eight patients with retrogeniculate lesions of the visual pathway were examined. Pupil field was evaulated by three skilled visual field interpreters masked to the patients' clinical data including conventional perimetry. The spatial concordance of the visual field and the pupil field was quantitatively assessed by the ratio of intersection area and union area of the observer's result and the visual field defect measured by conventional perimetry. The ratios in the two cohorts were compared by the Wilcoxon rank-sum test.
The concordance between pupil and conventional perimetry was better in the group of patients with retrogeniculate lesions. Ratios of the intersection area and the union area in this group were significantly higher than for the group with pregeniculate lesion of the visual pathway (p < 0.05).
According to our results, pupil campimetry demonstrates retrogeniculate visual pathway lesions well in contrast to pregeniculate lesions. This is in contradiction to the classical view of the pupillary pathways, where a retrogeniculate lesion actually should not influence pupillary function, whereas pregeniculate lesions should show pupillary scotomata. The cause might be that different components of the pupillary light reflex are being involved in pre-- and retrogeniculate lesions, and the stimulus characteristics of pupil perimetry address better the components represented in the retrogeniculate pathway.
我们研究的目的是证明瞳孔视野计再现由视觉通路膝状体前和膝状体后病变引起的视野缺损的能力。
通过红外视频瞳孔描记法，记录对视野刺激的光反应。刺激模式由41个直径为4度、亮度为140 cd/m²的测试点组成，分布在中央（30度）视野中。背景亮度为2.7 cd/m²。对8例视觉通路膝状体前病变患者和8例膝状体后病变患者进行了检查。由三名熟练的视野解读人员在不知道患者临床数据（包括传统视野检查）的情况下评估瞳孔视野。通过观察者结果的交集面积与并集面积之比以及传统视野检查测量的视野缺损，对视野和瞳孔视野的空间一致性进行定量评估。两组的比率通过Wilcoxon秩和检验进行比较。
在膝状体后病变患者组中，瞳孔视野与传统视野检查的一致性更好。该组的交集面积与并集面积之比显著高于视觉通路膝状体前病变组（p < 0.05）。
根据我们的结果，与膝状体前病变相比，瞳孔视野计能很好地显示膝状体后视觉通路病变。这与瞳孔通路的经典观点相矛盾，在经典观点中，膝状体后病变实际上不应影响瞳孔功能，而膝状体前病变应表现为瞳孔暗点。原因可能是瞳孔光反射的不同成分参与了膝状体前和膝状体后病变，并且瞳孔视野检查的刺激特征更好地针对了膝状体后通路中所代表的成分。
