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목적 : To objectively assess pupillary involvement according to various etiologies of acquired isolated oculomotor nerve palsy using digital pupillometry.
방법 : A total of 162 subjects were included in this study, consisting of 60 subjects with presumed microvascular ischemic oculomotor nerve palsy, 51 with non-ischemic oculomotor nerve palsy (21 inflammatory, 30 compressive), and 51 controls whose pupillary light responses were measured using a dynamic pupillometer. Pupillometry parameters were noted. Differences in pupillometry measurements were compared among diverse etiologies of oculomotor nerve palsy and controls. The interocular difference of the involved eye and the uninvolved fellow eye was calculated to adjust for individual variability.
결과 : With the diagnostic criteria using inter-eye difference of 1) minimum pupil diameter > 0.45 mm, or 2) pupillary constriction ratio < -7.5% compared to the fellow eye, the sensitivity and specificity for diagnosing compressive third nerve palsy were 95% and 88%, respectively. In the compressive group, positive correlations were found between the degree of external ophthalmoplegia and constriction ratio (r=0.615, p<0.001), average constriction velocity (r=0.591, p= 0.001) and maximum constriction velocity (r=0.582, p= 0.001).
결론 : Digital pupillometry showed relatively good performance for discriminating compressive lesions from microvascular ischemic third nerve palsy. A quantitative relationship between pupillary constriction parameters and external ophthalmoplegia was also found in compressive lesions.
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