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Ultraschall Med 2021; 42(01): 84-91
DOI: 10.1055/a-1208-1482
Original Article

Ultrasound Examination of the Pupil – A New Tool for the Neuro-Ophthalmological Assessment

Ultrasonographie der Pupille – eine neue Möglichkeit der Neuro-Ophtalmologischen Untersuchung
Filippo Farina‡
1   Department of Neuroscience, University of Padua School of Medicine, Stroke Unit and Neurosonology Laboratory, Padova, Italy
,
Milan R. Vosko‡
2   Department of Neurology 2, Kepler Universitätsklinikum, Med Campus III, Stroke Unit and Neurosonology Laboratory, Linz, Austria
,
Claudio Baracchini
1   Department of Neuroscience, University of Padua School of Medicine, Stroke Unit and Neurosonology Laboratory, Padova, Italy
,
Mario Ermani
3   Department of Neuroscience, University of Padua School of Medicine, Neurological Clinic, Padova, Italy
,
Peter Sommer
4   Department of Neurology, Krankenanstalt Rudolfstiftung Vienna, Austria
,
Stefan Greisenegger
5   Department of Neurology, Medical University of Vienna, Austria
,
Peter Laubichler
6   Department of Ophtalomology and Optometry, Kepler University Hospital GmbH, Johannes Kepler University Linz, Austria
,
Walter Struhal
7   Department of Neurology, University Clinic Tulln, Karl Landsteiner University of Health Sciences, Site Tulln, Austria
,
Lukas Kellermair
2   Department of Neurology 2, Kepler Universitätsklinikum, Med Campus III, Stroke Unit and Neurosonology Laboratory, Linz, Austria
,
Gerhard Ransmayr
2   Department of Neurology 2, Kepler Universitätsklinikum, Med Campus III, Stroke Unit and Neurosonology Laboratory, Linz, Austria
,
Cornelia Brunner
7   Department of Neurology, University Clinic Tulln, Karl Landsteiner University of Health Sciences, Site Tulln, Austria
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Abstract

Background Pupil examination represents a diagnostic and prognostic test in the management of several neurological diseases. Infrared video pupillometry (IVP) is the gold standard, since it is not routinely available, a noninvasive bedside ultrasound assessment has been proposed as an alternative. The aim of this study was to assess the feasibility and reproducibility of ultrasound pupillometry (UP) in comparison with IVP.

Materials and Methods 81 subjects (43 men and 38 women, mean age: 52 ± 20 years and 49 ± 19 years, respectively) with no history of neurophthalmologic disease were enrolled. UP was performed with a 12-MHz linear probe according to current guidelines for orbital insonation. Light and painful stimuli were applied to test pupillary light reflex (PLR) and ciliospinal reflex (CR). In 30 of these subjects IVP examination was performed additionally to obtain intra-observer and inter-observer agreement.

Results Increasing age was associated with a decreased pupillary diameter (PD) at rest, after PLR and CR (R –0.728, p < 0.01, R –0.643, p < 0.01, R 0.674, p < 0.001 respectively), while no association was noticed with time to constriction/dilation. UP measurements were reproducible (rate of inter- and intra-observer agreement: R 0.979, p < 0.01, R 0.946, p < 0.01 respectively) and concordant with IVP (PLR R 0.831, p < 0.01; CR R 0.879, p < 0.01).

Conclusion According to our study, ultrasound pupillometry is a feasible and reliable technique for bedside pupillary function assessment, and is a good alternative to infrared video pupillometry. Moreover, it represents the only way for functional pupillary assessment in patients with periorbital hematoma.

Zusammenfassung

Wissenschaftlicher Hintergrund Die Pupillenuntersuchung stellt einen wesentlichen diagnostischen und prognostischen Test bei verschiedenen neurologischen Erkrankungen dar. Der Goldstandard ist die Infrarot-Videopupillometrie (IVP). Da diese nicht routinemäßig verfügbar ist, wäre alternativ eine nichtinvasive Ultraschalluntersuchung der Pupille von großem diagnostischem Wert. Das Ziel dieser Studie war es, die Durchführbarkeit und Reproduzierbarkeit der Ultraschall-Pupillometrie (UP) mit der IVP zu vergleichen.

Material und Methoden 81 Probanden (43 männlich, 38 weiblich, mittleres Alter 52 ± 20 Jahre und 49 ± 19 Jahre) wurden in die Auswertung eingeschlossen. Es bestanden keine ophthalmologischen Vorerkrankungen. Die UP wurde mit einer 12MHz-Linear-Schallsonde entsprechend der derzeit gültigen Richtlinien einer orbitalen Sonografie durchgeführt. Die Pupillenreaktion wurde nach einem Lichtstimulus (Pupillenreflex, PR) sowie nach einer Schmerzapplikation im Bereich des Nackens (Ziliospinalreflex, ZSR) beurteilt. Bei 30 dieser Probanden wurde zusätzlich eine IVP-Untersuchung vollzogen, um zusätzlich die Inter- und Intra-Observer-Reliabilität zu messen.

Ergebnisse Ein höheres Alter war nach Testung des PR sowie des ZSR mit einem geringeren Pupillendurchmesser in Ruhe assoziiert (R = –0,728; p < 0,01; R = –0,643; p < 0,01; R 0,674; p < 0,001), wohingegen keine Assoziation in der Zeit von Pupillenkonstriktion/-dilatation bestand. Die UP-Messungen waren reproduzierbar (Inter- und Intra-Observer Übereinstimmung: R = 0,979; p < 0,01; R = 0,946; p < 0,01) und übereinstimmend mit der IVP (DPR: R = 0,831; p < 0,01; ZSR: R = 0,879; p < 0,01).

Schlussfolgerung Die aktuelle Studie zeigt, dass die Ultraschall-Pupillometrie eine verlässliche und reproduzierbare Methode zur Pupillenuntersuchung ist und eine gute Alternative zur Infrarot-Videopupillometrie darstellt. Insbesondere besteht damit bei traumatischen Augen(lid)verletzungen die einzige Möglichkeit, die Pupillenfunktion zu überprüfen, wenn z. B. das Augenlid aufgrund eines Hämatoms nicht geöffnet werden kann.

Key words

ultrasound - pupil - pupillary light reflex - ciliospinal reflex - video pupillometry


Publikationsverlauf

Eingereicht: 09. Februar 2020

Angenommen: 19. Juni 2020

Artikel online veröffentlicht:
20. Juli 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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