Park Jason C, Moss Heather E, McAnany J Jason
Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois, United States.
Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois, United States 2Department of Neurology & Rehabilitation, University of Illinois at Chicago, Chicago, Illinois, United States.
Invest Ophthalmol Vis Sci. 2016 Jan 1;57(1):23-9. doi: 10.1167/iovs.15-18181.
To evaluate the effects of idiopathic intracranial hypertension (IIH) on rod-, cone-, and melanopsin-mediated pupillary light reflexes (PLRs).
Pupillary light reflexes elicited by full-field, brief-flash stimuli were recorded in 13 IIH patients and 13 normal controls. Subjects were dark-adapted for 10 minutes and the PLR was recorded in response to short-wavelength flashes (0.001 cd/m2: rod condition; 450 cd/m2: melanopsin condition). Subjects were then exposed to a rod-suppressing field and 10 cd/m2 long-wavelength flashes were presented (cone condition). Pupillary light reflexes were quantified as the maximum transient constriction (rod and cone conditions) and the post-illumination pupil constriction (melanopsin condition), relative to the baseline pupil size. Diagnostic power was evaluated using receiver operating characteristic (ROC) analysis.
The IIH patients had significantly smaller PLRs under the melanopsin (P < 0.001) and rod (P = 0.04) paradigms; a trend for reduced cone-mediated PLRs was also found (P = 0.08). Receiver operating characteristic analysis indicated areas under the curves (AUC) of 0.83 (melanopsin-meditated; P = 0.001), 0.71 (rod-mediated; P = 0.07), and 0.77 (cone-mediated; P = 0.02). The AUC (0.90, P < 0.001), sensitivity (85%), and specificity (85%) were high for ROC analysis performed on the mean of the rod, cone, and melanopsin PLRs.
Pupillary light reflex reductions in IIH patients indicate compromised RGC function. PLR measurement, particularly under rod- and melanopsin-mediated conditions, may be a useful adjunct to standard clinical measures of visual function in IIH.
评估特发性颅内高压（IIH）对视杆细胞、视锥细胞和黑视蛋白介导的瞳孔光反射（PLR）的影响。
记录13例IIH患者和13名正常对照者在全视野、短暂闪光刺激下的瞳孔光反射。受试者暗适应10分钟，记录对短波长闪光（0.001 cd/m²：视杆细胞条件；450 cd/m²：黑视蛋白条件）的PLR。然后让受试者暴露于抑制视杆细胞的视野中，并呈现10 cd/m²的长波长闪光（视锥细胞条件）。瞳孔光反射以相对于基线瞳孔大小的最大瞬时收缩（视杆细胞和视锥细胞条件）和光照后瞳孔收缩（黑视蛋白条件）进行量化。使用受试者工作特征（ROC）分析评估诊断效能。
IIH患者在黑视蛋白（P < 0.001）和视杆细胞（P = 0.04）模式下的PLR明显较小；也发现视锥细胞介导的PLR有降低趋势（P = 0.08）。ROC分析表明曲线下面积（AUC）分别为0.83（黑视蛋白介导；P = 0.001）、0.71（视杆细胞介导；P = 0.07）和0.77（视锥细胞介导；P = 0.02）。对视杆细胞、视锥细胞和黑视蛋白PLR的平均值进行ROC分析时，AUC为0.90（P < 0.001），敏感性为85%，特异性为85%。
IIH患者瞳孔光反射降低表明视网膜神经节细胞（RGC）功能受损。PLR测量，尤其是在视杆细胞和黑视蛋白介导的条件下，可能是IIH视觉功能标准临床测量的有用辅助手段。
