Department of Surgery, University of Calgary, Calgary, Alberta, Canada.
Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.
Asia Pac J Ophthalmol (Phila). 2018 Jul-Aug;7(4):271-279. doi: 10.22608/APO.2018124. Epub 2018 Jul 12.
An elevated optic nerve head can be an ominous sign, sometimes signifying an underlying basis for raised intracranial pressure. Alternatively, patients may harbor a different mechanism for this optic nerve head appearance, including optic disc drusen (ODD), which does not confer any life-threatening implications. It is important to refine the approach to distinguishing ODD from papilledema because this is a relatively common, and important, conundrum encountered in clinical practice. Optical coherence tomography (OCT) is a noninvasive, readily accessible, and cost-effective ocular imaging technique that can improve the diagnostic accuracy for detecting ODD; or, instead, increase the index of suspicion for papilledema, thus prompting additional investigations needed to identify (or exclude) potential causes of raised intracranial pressure. In this review, we will discuss the value of OCT in the diagnostic approach to cases of mild optic disc elevation, with acknowledgment of the potential pearls and pitfalls of this imaging technology. In particular, we will emphasize the helpful role OCT can play in differentiating cases of ODD from mild papilledema in the context of idiopathic intracranial hypertension (IIH).
视神经头部抬高可能是一个不祥的迹象，有时表明颅内压升高的潜在基础。或者，患者可能存在这种视神经头部外观的不同机制，包括视盘玻璃疣（ODD），这不会带来任何危及生命的影响。重要的是要完善区分 ODD 和视盘水肿的方法，因为这是临床实践中相对常见且重要的难题。光学相干断层扫描（OCT）是一种非侵入性、易于获得且具有成本效益的眼部成像技术，可提高检测 ODD 的诊断准确性；或者，相反，增加对视盘水肿的怀疑指数，从而促使进行额外的检查以确定（或排除）颅内压升高的潜在原因。在这篇综述中，我们将讨论 OCT 在诊断轻度视盘抬高病例中的价值，并承认该成像技术的潜在优点和缺点。特别是，我们将强调 OCT 在特发性颅内高压（IIH）背景下区分 ODD 和轻度视盘水肿病例方面的有益作用。
