Department of Neuroscience, University of Padua School of Medicine, Stroke Unit and Neurosonology Laboratory, Padova, Italy.
Department of Neurology 2, Kepler Universitätsklinikum, Med Campus III, Stroke Unit and Neurosonology Laboratory, Linz, Austria.
Ultraschall Med. 2021 Feb;42(1):84-91. doi: 10.1055/a-1208-1482. Epub 2020 Jul 20.
Pupil examination represents a diagnostic and prognostic test in the management of several neurological diseases. Infrared video pupillometry (IVP) is the gold standard, since it is not routinely available, a noninvasive bedside ultrasound assessment has been proposed as an alternative. The aim of this study was to assess the feasibility and reproducibility of ultrasound pupillometry (UP) in comparison with IVP.
81 subjects (43 men and 38 women, mean age: 52 ± 20 years and 49 ± 19 years, respectively) with no history of neurophthalmologic disease were enrolled. UP was performed with a 12-MHz linear probe according to current guidelines for orbital insonation. Light and painful stimuli were applied to test pupillary light reflex (PLR) and ciliospinal reflex (CR). In 30 of these subjects IVP examination was performed additionally to obtain intra-observer and inter-observer agreement.
Increasing age was associated with a decreased pupillary diameter (PD) at rest, after PLR and CR (R -0.728, p < 0.01, R -0.643, p < 0.01, R 0.674, p < 0.001 respectively), while no association was noticed with time to constriction/dilation. UP measurements were reproducible (rate of inter- and intra-observer agreement: R 0.979, p < 0.01, R 0.946, p < 0.01 respectively) and concordant with IVP (PLR R 0.831, p < 0.01; CR R 0.879, p < 0.01).
According to our study, ultrasound pupillometry is a feasible and reliable technique for bedside pupillary function assessment, and is a good alternative to infrared video pupillometry. Moreover, it represents the only way for functional pupillary assessment in patients with periorbital hematoma.
瞳孔检查是几种神经疾病管理中的一种诊断和预后测试。红外视频瞳孔测量（IVP）是金标准，但由于其无法常规获得，因此已经提出了一种非侵入性的床边超声评估作为替代方法。本研究旨在评估超声瞳孔测量（UP）与 IVP 相比的可行性和可重复性。
共纳入 81 名（男性 43 名，女性 38 名，平均年龄分别为 52±20 岁和 49±19 岁）无神经眼科疾病史的受试者。根据目前的眶内超声成像指南，使用 12MHz 线性探头进行 UP。施加光和疼痛刺激以测试瞳孔光反射（PLR）和睫状脊髓反射（CR）。在其中 30 名受试者中，还进行了 IVP 检查，以获得观察者内和观察者间的一致性。
年龄的增加与静息时、PLR 后和 CR 后的瞳孔直径（PD）减小相关（R -0.728，p<0.01，R -0.643，p<0.01，R 0.674，p<0.001），而与收缩/扩张时间无关。UP 测量具有可重复性（观察者内和观察者间的一致性率：R 0.979，p<0.01，R 0.946，p<0.01），并且与 IVP 一致（PLR R 0.831，p<0.01；CR R 0.879，p<0.01）。
根据我们的研究，超声瞳孔测量是一种可行且可靠的床边瞳孔功能评估技术，是红外视频瞳孔测量的良好替代方法。此外，它是眶周血肿患者进行功能性瞳孔评估的唯一方法。
