Children's Hospital of Los Angeles, Roski Eye Institute, University of Southern California, Los Angeles, California.
Department of Ophthalmology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Ophthalmology. 2020 Oct;127(10):1416-1423. doi: 10.1016/j.ophtha.2020.03.027. Epub 2020 May 5.
To review the published literature on the accuracy of ophthalmic imaging methods to differentiate between papilledema and pseudopapilledema in children.
Literature searches were conducted in January 2020 in the PubMed database for English-language studies with no date restrictions and in the Cochrane Library database without any restrictions. The combined searches yielded 354 abstracts, of which 17 were reviewed in full text. Six of these were considered appropriate for inclusion in this assessment and were assigned a level of evidence rating by the panel methodologist. All 6 included studies were rated as level III evidence.
Fluorescein angiography, a combination of 2 OCT protocols, and multicolor confocal scanning laser ophthalmoscopy (Spectralis SD-OCT; Heidelberg Engineering, Heidelberg, Germany) demonstrated the highest positive percent agreement (92%-100%; 95% confidence interval [CI], 69%-100%) and negative percent agreement (92%-100%; 95% CI, 70%-100%) with a clinical diagnosis of papilledema in children. However, results must be interpreted with caution owing to methodologic limitations, including a small sample size leading to wide CIs and an overall lack of data (there was only 1 study each for the above methods and protocols). Ultrasonographic measures showed either a high positive percent agreement (up to 95%) with low negative percent agreement (as low as 58%) or vice versa. Autofluorescence and fundus photography showed a lower positive (40%-60%) and negative (57%) percent agreement.
Although several imaging methods demonstrated high positive and negative percent agreement with clinical diagnosis, no ophthalmic imaging method conclusively differentiated papilledema from pseudopapilledema in children because of the lack of high-quality evidence. Clinicians must continue to conduct thorough history-taking and examination and make judicious use of ancillary testing to determine which children warrant further workup for papilledema.
回顾已发表的关于眼科影像学方法在儿童中区分视盘水肿和假性视盘水肿准确性的文献。
2020 年 1 月，在 PubMed 数据库中对无时间限制的英文文献进行了文献检索，并在 Cochrane 图书馆数据库中进行了无限制检索。联合检索产生了 354 篇摘要，其中 17 篇进行了全文审查。其中 6 篇被认为适合纳入本评估，并由小组方法学家进行了证据水平评级。所有 6 项纳入的研究均被评为 III 级证据。
荧光素血管造影、两种 OCT 方案的组合以及多色共焦扫描激光检眼镜（Spectralis SD-OCT；Heidelberg Engineering，Heidelberg，Germany）显示出与儿童视盘水肿临床诊断的最高阳性百分比一致性（92%-100%；95%置信区间 [CI]，69%-100%）和阴性百分比一致性（92%-100%；95%CI，70%-100%）。然而，由于方法学限制，结果必须谨慎解释，包括小样本量导致宽 CI 和总体缺乏数据（上述方法和方案中每个方法仅有 1 项研究）。超声测量显示阳性百分比一致性较高（高达 95%），阴性百分比一致性较低（低至 58%）或反之亦然。自发荧光和眼底照相显示出较低的阳性（40%-60%）和阴性（57%）百分比一致性。
尽管几种影像学方法与临床诊断显示出较高的阳性和阴性百分比一致性，但由于缺乏高质量的证据，没有任何眼科影像学方法能够明确区分儿童的视盘水肿和假性视盘水肿。临床医生必须继续进行彻底的病史采集和检查，并明智地使用辅助检查来确定哪些儿童需要进一步检查视盘水肿。
