Kardon R H, Corbett J J, Thompson H S
Department of Ophthalmology, University of Iowa Hospitals and Clinics, Iowa City, USA.
Ophthalmology. 1998 Feb;105(2):313-21. doi: 10.1016/s0161-6420(98)93328-0.
This study aimed to analyze the denervation and reinnervation history of individual segments of the iris sphincter in patients with Adie's syndrome.
The irises of these patients were retroilluminated by shining an infrared-rich light through the lower eyelid and sclera and viewing the transilluminated iris from the front with an infrared-sensitive video camera. The irises of the same group of patients also were videotaped through a slit-lamp camera using routine frontal illumination. Both of these techniques also were used to examine a series of normal subjects.
A total of 61 patients with Adie's syndrome or Adie's-like denervation of the iris sphincter (from surgery, trauma, or radiation) and 10 normal subjects were studied.
Slit-lamp examination results of the segmental movement of the iris were compared to the infrared transillumination pattern of the iris sphincter before and during the light reflex, before and during the near-vision reaction, before and during eye movement, and before and after the application of dilute pilocarpine and 1% pilocarpine.
Whenever an iris sphincter segment contracted, it also became denser by using these techniques. Reinnervated iris segments failed to contract to light but did contract and became denser with a near effort or with eye movement. Segments supersensitive to pilocarpine became denser than adjacent segments without supersensitivity, but atrophic-appearing segments looked translucent and thin, failing to become denser, even with 1% pilocarpine.
The innervational history and current status of each clock-hour segment of the iris sphincter can be determined using this technique of videographic infrared transillumination, and the progression and pattern of iris denervation and reinnervation can be determined in patients with Adie's pupil. A miotic Adie's pupil that is "tonic," even in darkness, was found to be associated with a dense pattern of infrared transillumination in sphincter segments, which the authors interpret as being associated with a rich reinnervation from accommodative fibers. Segments that become densely reinnervated appear to lose their cholinergic supersensitivity.
本研究旨在分析阿-狄氏综合征患者虹膜括约肌各段的去神经支配和再支配历史。
通过在下眼睑和巩膜处照射富含红外线的光，并使用对红外线敏感的摄像机从正面观察透照的虹膜，对这些患者的虹膜进行后照法检查。同一组患者的虹膜也使用常规正面照明通过裂隙灯相机进行录像。这两种技术也用于检查一系列正常受试者。
共研究了61例患有阿-狄氏综合征或因手术、创伤或辐射导致虹膜括约肌出现类阿-狄氏去神经支配的患者以及10名正常受试者。
将虹膜节段运动的裂隙灯检查结果与虹膜括约肌在光反射前和反射期间、近视力反应前和反应期间、眼球运动前和运动期间以及应用稀释毛果芸香碱和1%毛果芸香碱前后的红外线透照模式进行比较。
使用这些技术时，每当虹膜括约肌节段收缩，它也会变得更致密。重新获得神经支配的虹膜节段对光无收缩反应，但在近视力努力或眼球运动时会收缩并变得更致密。对毛果芸香碱超敏感的节段比相邻无超敏感性的节段更致密，但外观萎缩的节段看起来半透明且薄，即使使用1%毛果芸香碱也不会变得更致密。
使用这种视频红外线透照技术可以确定虹膜括约肌每个钟点节段的神经支配历史和当前状态，并且可以确定阿-狄氏瞳孔患者虹膜去神经支配和再支配的进展及模式。发现即使在黑暗中呈“强直性”的缩瞳阿-狄氏瞳孔与括约肌节段密集的红外线透照模式相关，作者将其解释为与来自调节纤维的丰富再支配有关。重新获得密集神经支配的节段似乎失去了胆碱能超敏感性。
