Kupersmith Mark J, Sibony Patrick A, Feldon Steven E, Wang Jui-Kai, Garvin Mona, Kardon Randy
Mount Sinai West Hospital, New York, New York; New York Eye and Ear Infirmary and Icahn School of Medicine at Mount Sinai, New York, New York.
Department of Ophthalmology, State University of New York at Stony Brook, Stony Brook, New York.
Am J Ophthalmol. 2017 Apr;176:77-86. doi: 10.1016/j.ajo.2016.12.017. Epub 2016 Dec 28.
We described 3 types of folds in the retina and a crease in the outer retina associated with papilledema owing to idiopathic intracranial hypertension (IIH) at presentation. We report the change in folds relative to treatment of IIH over the 6 months.
In this substudy of a randomized clinical trial, study eyes of subjects assigned to acetazolamide (ACZ, n = 44) or placebo (PLB, n = 43) had spectral-domain optical coherence tomography (SDOCT) images of the optic disc and macula regions at baseline and at 3 and 6 months. Images were evaluated for peripapillary wrinkles (PPW), retinal folds (RF), choroidal folds (CF), and creases using transaxial and en face views. The optic nerve head (ONH) shape, retinal nerve fiber layer (RNFL) thickness, ONH volume, and papilledema grade were measured. Outcome was determination of the presence or absence of PPW, RF, CF, and creases.
At presentation, except for an increase of PPW in ACZ eyes (64% vs 28%), both treatment groups were matched for all OCT features. At 6 months, ACZ-treated, but not PLB-treated, eyes had fewer folds of all types (P < .01), with a 57% reduction in frequency of RF. Creases did not resolve. Resolution of RF, but not of PPW and CF, was associated with significant reduction in RNFL thickness, ONH volume, and papilledema grade.
The various types of retinal folds associated with papilledema reflect biodynamic processes and show an ACZ treatment effect. Persistence of these folds despite marked improvement in ONH swelling suggests permanent changes in the affected retinal tissues.
我们描述了视网膜的3种褶皱类型以及与特发性颅内高压（IIH）所致视乳头水肿相关的视网膜外层褶皱。我们报告了6个月内这些褶皱相对于IIH治疗的变化情况。
在这项随机临床试验的子研究中，分配至乙酰唑胺（ACZ，n = 44）或安慰剂（PLB，n = 43）组的受试者的研究眼在基线、3个月和6个月时接受了视盘和黄斑区的光谱域光学相干断层扫描（SDOCT）图像检查。使用横断面和正面视图评估图像中的视乳头周围皱纹（PPW）、视网膜褶皱（RF）、脉络膜褶皱（CF）和褶皱情况。测量视神经乳头（ONH）形状、视网膜神经纤维层（RNFL）厚度、ONH体积和视乳头水肿分级。结果是确定PPW、RF、CF和褶皱的有无。
就诊时，除ACZ组眼的PPW增加（64%对28%）外，两个治疗组在所有OCT特征方面均匹配。6个月时，接受ACZ治疗而非PLB治疗的眼所有类型的褶皱均减少（P <.01），RF频率降低57%。褶皱未消退。RF的消退而非PPW和CF的消退与RNFL厚度、ONH体积和视乳头水肿分级的显著降低相关。
与视乳头水肿相关的各种类型视网膜褶皱反映了生物动力学过程，并显示出ACZ治疗效果。尽管ONH肿胀明显改善，但这些褶皱仍然存在，提示受影响的视网膜组织发生了永久性变化。
