Yu Caberry W, Micieli Jonathan A
Faculty of Medicine, Queen's University, Kingston, Canada.
Department of Ophthalmology and Vision Sciences and Division of Neurology, Department of Medicine, University of Toronto, Toronto, Canada; Kensington Vision and Research Centre, Toronto, Canada.
J Neurol Sci. 2020 Nov 15;418:117160. doi: 10.1016/j.jns.2020.117160. Epub 2020 Sep 28.
Bilateral optic disc edema (ODE) with preserved visual function is typically a result of papilledema, but the causes of this finding in the absence of raised intracranial pressure have not been systematically evaluated. The goal of this study was to determine the causes of bilateral ODE with preserved visual function not related to intracranial hypertension to help in developing a differential diagnosis for this finding. We retrospectively reviewed 221 consecutive patients presenting to a tertiary neuro-ophthalmology practice over a period of 2 years. Four patients met the inclusion criteria with a mean age of 53 years (range 43 to 63), 2 patients were men and 2 were women. The final diagnoses were bilateral optic perineuritis secondary to p-ANCA vasculitis, bilateral incipient non-arteritic anterior ischemic optic neuropathy (NAION), hypertensive emergency, and intermediate uveitis. The patient with NAION developed an inferior altitudinal defect 4 months after presentation, but all other patients maintained normal visual function. The ODE resolved in all cases at a mean follow-up of 4.5 months (range 3 to 6 months). Optic disc edema with preserved visual function may not be related to papilledema, and this series indicates that optic perineuritis, incipient NAION, hypertensive emergency, and intermediate uveitis be considered in the differential diagnosis of these cases.
双侧视盘水肿（ODE）且视功能保留通常是视乳头水肿的结果，但在颅内压不升高的情况下出现这一表现的原因尚未得到系统评估。本研究的目的是确定双侧ODE且视功能保留且与颅内高压无关的原因，以帮助对此表现进行鉴别诊断。我们回顾性分析了2年期间在一家三级神经眼科诊所连续就诊的221例患者。4例患者符合纳入标准，平均年龄53岁（范围43至63岁），2例为男性，2例为女性。最终诊断为继发于p-ANCA血管炎的双侧视神经周围炎、双侧早期非动脉炎性前部缺血性视神经病变（NAION）、高血压急症和中间葡萄膜炎。NAION患者在就诊后4个月出现下象限视野缺损，但所有其他患者视功能保持正常。平均随访4.5个月（范围3至6个月）时，所有病例的ODE均消退。视功能保留的视盘水肿可能与视乳头水肿无关，本系列研究表明，在这些病例的鉴别诊断中应考虑视神经周围炎、早期NAION、高血压急症和中间葡萄膜炎。
