에이디 긴장성 동공의 임상양상
Clinical Features of Adie’s Tonic Pupil: A Retrospective and Cross-Sectional Study
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목적: 에이디 긴장성 동공으로 진단받은 환자의 임상양상을 알아보고자 하였다. 대상과 방법: 1998년 2월에서 2009년 2월까지 에이디 긴장성 동공으로 진단 받은 환자 22명의 의무기록을 후향적으로 연구하였다. 이 중 16명(19안)을 2010년 3월에 내원하게 하여 한 사람의 검사자가 단면적 검사(cross-sectional examination)를 시행하였다. 결과: 남자보다 여자에게서 많이 발생하였고, 양안 발생률은 13.6%였다. 평균 발병나이는 38.3세였고, 100%에서 동공의 탈신경 과민반응을 보였으며 최대반응은 20분 후에 나타났다. 동공 대광－근접반사해리 현상을 보이는 경우가 88.2%였고, 홍채 부분마비는 93.8%에서 보였으며, 각막지각 감소가 50%에서 나타났고, 심부건반사는 이두근, 삼두근, 무릎, 발목반사 모두에서 저하되었다. 결론: 에이디 긴장성 동공은 여자에서 호발하고(72.7%), 젊은 나이에 발병하며, 편측에서 발생한 경우가 86.4%였다. 홍채의 부분마비,동공 대광-근접반사해리, 탈신경 과민반응과 심부건반사 저하 또는 소실이 진단에 도움이 된다. 조절력은 시간이 지남에 따라 호전되었고, 동공크기도 줄어들었다.
Abstract
Purpose: To report the clinical features of Adie’s tonic pupil. Methods: The medical records of 22 patients who had been diagnosed with Adie’s tonic pupil from February 1998 to February 2009, were retrospectively reviewed. On March 2010, a cross-sectional examination was performed in 16 patients (19 eyes) who underwent a follow-up of more than 1 year. Measurements included pupil size in room light, bright light and in darkness; near point of accommodation; presence of segmental iris palsy; light-near dissociation; denervation supersensitivity;corneal sensitivity; and deep tendon reflex (DTR). Results: Among the patients studied, 16 were women in Adie’s tonic pupils. Only 3 of patients had bilateral involvement. The mean age of onset was 38.3 years. The mean size of Adie’s tonic pupils was 2.3 mm larger than the fellow eyes. Segmental iris palsy was detected in 93.8% of the patients. Denervation supersensitivity was observed in all patients. Light-near dissociation was present in 88.2% and over 90% of the patients had decreased DTR in the biceps, triceps, knee and ankle jerk. Conclusions: This cross-sectional study showed Adie’s tonic pupil tended to become miotic and recover accommodation power over the years.
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