％縮瞳量，％速度を加えた新しい分析法による対光反応の研究—第3報 自律神経作働薬点眼の対光反応に及ぼす影響の加齢変化

Age distribution of effect of topical pilocarpine and epinephrine on the pupil

　ピロカルピンならびにエピネフリン点眼は瞳孔緊張症とHorner症候群の診断に必須であるが，その影響を年代別に詳細に対光反応から検討した報告はない。年代別に約50例を対象にこれら点眼剤の対光反応に及ぼす影響を検討した。対光反応はopen-loop下光刺激の可能なイリスコーダーを用いて測定した。ピロカルピン点眼の影響は瞳孔の大きさ・％Aに現われ，加齢に従い増大していた。DPE点眼の影響は瞳孔の大きさ・％VDmaxに現われ，加齢とともに亢進していた。この加齢変化は副交感・交感両神経系の脱神経後の過敏性と角膜薬剤透過性の亢進が合わさったものと考えられた。今後はここで得た年代別正常値をもとに，薬剤に対する過敏性を判定することができる。

Although pupillary supersensitivity to topical pilocarpine as well as topical epinephrine are an important sign to make a diagnosis of tonic pupil and Horner's syndrome, a detailed study of aging effect of these autonomic agents on the pupil has not been reported. Therefore, we investigated the effects of topical pilocarpine (0.0313%) and topical dipivalyl epinephrine (DPE, 0.04%) on the pupillary light reflexes of 50 normal subjects aged 10 to more than 70 years using an infrared videopupillogram which could provide photic stimuli under the open-loop condition. Before and 60 minutes after the instillation, pupillary light reflexes were measured five times on each eyes, and the averaged values of five pupillary parameters were obtained. Topical pilocarpine significantly changed the pupil area and %-amplitude of constriction in the aged subjects. Topical DPE also altered the pupil area and maxi-mum %-velocity of dilatation of the old. The pupillary changes were significant in the subjects aged 30 years or more and the aged pupil showed the supersensitivity to both autonomics. We thought the pupillary supersensitivity in the aged could have resulted from the increase of the sensi-tivity of the receptors of the iris sphincter muscle as well as the iris dilator muscle and the higher pene-tration of the aged cornea. In addition we are able to detect the sensitivity of the patients' pupil comparing to the normal values of each age groups.