Bidot Samuel, Clough Lindsay, Saindane Amit M, Newman Nancy J, Biousse Valérie, Bruce Beau B
Departments of Ophthalmology (SB, LC, NJN, VB, BBB), Radiology and Imaging Science (AMS), Neurology (NJN, VB, BBB), and Neurological Surgery (NJN), Emory University School of Medicine, Atlanta, Georgia; and Department of Epidemiology (BBB), Rollins School of Public Health and Laney Graduate School, Emory University, Atlanta, Georgia.
J Neuroophthalmol. 2016 Jun;36(2):120-5. doi: 10.1097/WNO.0000000000000318.
To determine whether the size of the bony optic canal is associated with the severity of papilledema and poor visual function in idiopathic intracranial hypertension (IIH).
We performed a retrospective review of definite patients with IIH with requisite brain magnetic resonance imaging allowing for optic canal measurement. Clinical characteristics and automated (Humphrey) visual field results were reviewed; papilledema was graded according to the modified Frisén scale. Cross-sectional area of the optic canals was measured independently by 2 readers and averaged for each canal. Logistic regression modeling was applied.
Sixty-nine patients with IIH were included (mean age: 33; 91% women; 65% black). Controlling for age, sex, body mass index, race, and cerebrospinal fluid (CSF) opening pressure, each mm increase in canal size was associated with a 0.50 dB reduction in Humphrey visual field mean deviation (P = 0.006); this was likely mediated by the increased odds of Grade 4-5 papilledema or optic atrophy in patients with larger canals (odds ratio: 1.30 [95% CI: 1.10-1.55; P = 0.003] for Grade 4-5 papilledema or atrophy vs grade <4 papilledema per mm increase in canal size).
Poor visual function and severe papilledema or optic atrophy were associated with a larger optic canal. Potential mechanisms include alteration of local CSF flow or bony remodeling at the optic canals.
确定在特发性颅内高压（IIH）中，视神经管大小是否与视乳头水肿严重程度及视力功能不佳相关。
我们对确诊为IIH且有必要进行脑磁共振成像以测量视神经管的患者进行了回顾性研究。回顾了临床特征和自动（Humphrey）视野检查结果；视乳头水肿根据改良的弗里森量表进行分级。由两名阅片者独立测量视神经管的横截面积，并计算每条视神经管的平均值。应用逻辑回归模型。
纳入69例IIH患者（平均年龄：33岁；91%为女性；65%为黑人）。在控制年龄、性别、体重指数、种族和脑脊液（CSF）初压后，视神经管大小每增加1毫米，Humphrey视野平均偏差降低0.50分贝（P = 0.006）；这可能是由于视神经管较大的患者出现4 - 5级视乳头水肿或视神经萎缩的几率增加所致（视神经管大小每增加1毫米，4 - 5级视乳头水肿或萎缩与<4级视乳头水肿相比的优势比为1.30 [95% CI：1.10 - 1.55；P = 0.003]）。
视力功能不佳以及严重的视乳头水肿或视神经萎缩与较大的视神经管相关。潜在机制包括局部脑脊液流动改变或视神经管处的骨质重塑。
