Oculus角膜地形图仪在测量瞳孔直径及对光反射评估中的应用

The use of an Oculus keratograph to assess pupillary size and light reflex

目的 评价Oculus角膜地形图仪在测量不同光照强度下瞳孔直径及瞳孔对光反射的应用价值及测量的可重复性.方法 横断面研究.采用Oculus角膜地形图仪观察125例（125眼）患者不同光照刺激下（无光刺激,短光刺激及长光刺激模式）的瞳孔直径及对光反射,记录各瞳孔参数.分别采用独立样本t检验和单因素方差分析验证不同性别组与不同屈光度组的瞳孔参数的差异;配对t检验分析患者长光刺激模式刺激后1 s与5 s瞳孔直径差异.以组内相关系数（ICC）及Bland-Altman分布作为评判重复性、再现性的指标.结果 3种测量模式下最大瞳孔直径差异无统计学意义（F=1.03,P＞0.05）;无光刺激模式中最小瞳孔直径,最大瞳孔直径及直径极差分别为（5.34±0.95）mm,（6.18±0.85）mm及（0.86±0.37）mm.短光刺激模式中最小、最大瞳孔直径,直径极差,光刺激后1 s瞳孔直径分别为（3.57±0.74）mm,（6.10±0.92）rmm,（2.54±0.40）mm和（2.34±0.46） mm.长光刺激模式中最小、最大瞳孔直径,直径极差,光刺激开始1 s后及5 s后的瞳孔直径分别为（2.69±0.45） mm,（5.94±0.84）mm,（3.27±0.55）mm,（2.72±0.58）mm和（2.94±0.47） mm.长光刺激模式中光刺激后1 s与5 s瞳孔直径差异有统计学意义（t=0.38,P＜0.01）.各瞳孔参数的ICC均大于0.800; Bland-Altman分布显示的一致性范围均小于或接近1.0 mm.不同屈光度组及不同性别各瞳孔参数差异无统计学意义.结论 Oculus角膜地形图仪能测量不同光照度下的瞳孔直径,并可用于评估瞳孔对光反射.其测量结果有较好的可重复性和一致性。

Objective To assess the role of an oculus keratograph in the measurement of pupil size under scotopic illumination and pupil reflection at 3 photostimulation modes.Methods One hundred twenty-five subjects （125 eyes） were enrolled in this cross-sectional study.Pupil parameters were measured by two ophthalmologists under 3 photosti-mulation modes （scotopic conditions,pupillogram and anisocoria）.An independent sample t test and ANOVA test were used to verify the differences in pupil parameters between genders and refractive error groups.The differences in pupil size after different stimulations were analyzed by a paired t test.The reproducibility of the measurements was analyzed by an intraclass correlation coefficient （ICC） and Bland-Altman plot.Results The differences were not statistically significant for the largest pupils under the 3 conditions （F=1.03,P〉0.05）.Under scotopic conditions,the minimum,maximum and range of pupil size were 5.34±0.95 mm,6.18±0.85 mm and 0.86±0.37 mm,respectively.Under pupillogram mode,the pupil diameter of minimum and maximum,and range of pupil size and pupil diameter 1 second after stimulation were 3.57±0.74 mm,6.10±0.92 mm,2.54±0.40 mm and 2.34±0.46 mm,respectively.For anisocoric conditions,the minimum,maximum and range of pupil size and pupil diameter for 1 and 5 seconds after stimulation were 2.69±0.45 mm,5.94±0.84 mm,3.27±0.55 mm,2.72±0.58 mm and 2.94±0.47 mm,respectively.There was a statistically significant difference in pupil size for 1 and 5 seconds with anisocoria （t=0.38,P〈0.01）.The ICCs of intraobserver and interobserver were all higher than 0.800.Pupil size was not correlated with gender or refractive error.Conclusion The oculus keratograph can be used to measure pupil size and pupil reflection under different photostimulations and illumination levels with a high degree of reproducibility.