强直性瞳孔行两种浓度毛果芸香碱药物试验的临床观察

Clinical observation of two concentrations of pilocarpine drugs test for tonic pupil

目的观察强直性瞳孔患者行0.125%和0.0625%毛果芸香碱药物试验瞳孔变化特点,对比两种药物试验结果的差别。方法 20例(25眼)强直性瞳孔患者行0.125%和0.0625%毛果芸香碱药物试验,双眼结膜囊内间隔24 h以上各滴入1滴0.125%和0.0625%毛果芸香碱,观察双眼瞳孔变化特点。结果 20例(25眼)强直性瞳孔中,药物试验30 min时可观察到患眼瞳孔明显收缩,45 min时瞳孔收缩幅度最大。15例单眼强直性瞳孔行0.125%毛果芸香碱药物试验45 min时,健眼瞳孔收缩7眼;行0.0625%浓度毛果芸香碱试验45 min时,1例健眼出现收缩。15例单眼强直性瞳孔行两种浓度毛果芸香碱试验45 min时,患眼瞳孔小于健眼11例,患眼瞳孔仍大于健眼4例,但患眼瞳孔收缩幅度均大于健眼。结论强直性瞳孔药物试验时,0.0625%毛果芸香碱较0.125%浓度毛果芸香碱行药物试验假阳性反应更少出现。毛果芸香碱药物试验应以患眼瞳孔明显收缩且健眼瞳孔不变为阳性判定标准。

Objective To observe characteristics of pupil changes by 0.125% and 0.0625% of pilocarpine drugs test for tonic pupil patients, and to compare differences between these two drugs test. Methods A total of 20 patients （25 eyes） with tonic pupil received 0.125% and 0.0625% of piloearpine drugs test. They respectively received 1 drop of 0.125% and 0.0625% of pilocarpine in both conjunctival sacs with interval time over 24 h. Their changes of pupil were observed. Results In the 20 cases （25 eyes） with tonic pupil, drug test to 30 min showed obvious pupil contraction, and the largest contraction appeared in 45 min. There were 7 healthy eyes with pupil contraction among 15 single eyes receiving 0.125% pilocarpine drugs test in 45 min. There was 1 healthy eye with pupil contraction when receiving 0.0625% pilocarpine drugs test in 45 rain. In 45 min of drugs test by two concentrations of pilocarpine for 15 single eyes, there were 11 cases with smaller affected pupil than healthy eye and 4 cases with larger affected pupil than healthy eyes. Their pupil contraction degrees in affected eyes were all larger than that in healthy eyes. Conclusion In drug test for tonic pupil, 0.0625% of pilocarpine can provide less false positive reactions than 0.125% of pilocarpine. The positive judgment standard in pilocarpine drug test should be set as obvious pupil contraction in affected eye and stable pupil in healthy eye.