Fleischman David, Perry Jennifer T, Rand Allingham R, Stinnett Sandra S, Fleischman Gita M, Givre Syndee J, Chesnutt David A
Department of Ophthalmology, University of North Carolina Hospitals, Chapel Hill, North Carolina.
Department of Ophthalmology, Brown University, Providence, Rhode Island.
Can J Ophthalmol. 2017 Feb;52(1):26-29. doi: 10.1016/j.jcjo.2016.07.021. Epub 2016 Nov 17.
Some case reports suggest that the translaminar pressure difference is important in cases of papilledema. The purpose of this study was to determine ocular, physiologic, and demographic factors associated with papilledema severity.
Retrospective, blinded study.
Patients who had undergone a diagnostic lumbar puncture and had a diagnosis of papilledema in conjunction with idiopathic intracranial hypertension between 2004 and 2012 were included in the study. One-hundred and fifty-one patients were identified in initial screening. Sixty of 151 patients met all inclusion criteria, and 120 eyes were eligible for investigation.
A retrospective review of optic nerve photographs by 2 masked experts was used to grade papilledema severity using the Modified Frisén Scale (MFS). Patients with any systemic or neurologic disease that could affect cerebrospinal fluid pressure (CSFP) were excluded. Patients on acetazolamide were excluded. Assessments within 1 MFS grade were averaged and correlated to intraocular pressure, CSFP, translaminar pressure differential, MFS, age, weight, height, and systolic and diastolic blood pressure.
In univariate and multivariate type 3 generalized estimating equation analyses, only age (Z = -2.70; p < 0.01) and sex (Z = 2.81; p < 0.0001) were significantly correlated with MFS.
Papilledema severity decreased with advancing age and was higher for female sex. We found no association between severity of papilledema and CSFP, intraocular pressure, blood pressure, or any other physiologic parameter. Factors other than the translaminar pressure differential may be important in determining the severity of papilledema.
一些病例报告表明，跨筛板压力差在视乳头水肿病例中很重要。本研究的目的是确定与视乳头水肿严重程度相关的眼部、生理和人口统计学因素。
回顾性、盲法研究。
纳入2004年至2012年间接受诊断性腰椎穿刺并诊断为视乳头水肿合并特发性颅内高压的患者。初步筛查确定了151例患者。151例患者中有60例符合所有纳入标准，120只眼符合研究条件。
由2名蒙面专家对视神经照片进行回顾性评估，使用改良弗里森量表（MFS）对视乳头水肿严重程度进行分级。排除任何可能影响脑脊液压力（CSFP）的全身性或神经系统疾病患者。排除使用乙酰唑胺的患者。将1个MFS等级内的评估结果进行平均，并与眼压、CSFP、跨筛板压力差、MFS、年龄、体重、身高以及收缩压和舒张压相关联。
在单变量和多变量3型广义估计方程分析中，只有年龄（Z = -2.70；p < 0.01）和性别（Z = 2.81；p < 0.0001）与MFS显著相关。
视乳头水肿严重程度随年龄增长而降低，女性更高。我们发现视乳头水肿严重程度与CSFP、眼压、血压或任何其他生理参数之间无关联。除跨筛板压力差外的其他因素可能对视乳头水肿严重程度起重要作用。
