Elhusseiny Abdelrahman M, Fong Joseph W, Hsu Christine, Grigorian Florin, Grigorian A Paula, Soliman Mohamed K, Sallam Ahmed B, Uwaydat Sami H, Phillips Paul H
From the Department of Ophthalmology (A.M.E., J.W.F., C.H., F.G., A.P.G., A.B.S., S.H.U., P.H.P.), Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
From the Department of Ophthalmology (A.M.E., J.W.F., C.H., F.G., A.P.G., A.B.S., S.H.U., P.H.P.), Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas; and the Department of Ophthalmology (J.W.F., M.K.S.), Hamilton Eye Institute, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
Am J Ophthalmol. 2023 Jan;245:8-13. doi: 10.1016/j.ajo.2022.08.020. Epub 2022 Sep 6.
To evaluate the accuracy and safety of oral fluorescein angiography (OFA) in differentiating papilledema from pseudopapilledema in pediatric patients.
Retrospective evaluation of a diagnostic test.
We retrospectively reviewed medical records of all children ≤18 years of age who presented to the Arkansas Children's Hospital between May 2018 and August 2021 with suspected optic disc (OD) swelling that had OFA and images >30 minutes after oral ingestion. Two masked specialists interpreted the images as either OD leakage, no leakage, or borderline leakage. Optic disc swelling was graded clinically according to the Frisen grading scale (0-5). We compared OFA images to the final clinical diagnosis and calculated the accuracy of the test as follows: (number of eyes correctly identified as papilledema [true positive] + number of eyes correctly identified as pseudopapilledema [true negative]) / (total number of eyes) × 100%.
Forty-five patients (90 eyes) were included, 11 patients with papilledema and 34 with pseudopapilledema. The mean age was 14.1 ± 3.5 years; 66.7% were female. The accuracy of OFA was 62% for reviewer 1 and 69% for reviewer 2. No ocular or systemic side effects after OFA were observed. There was substantial agreement (k = 0.779) between both reviewers in grading the OFA images.
OFA cannot definitively distinguish papilledema from pseudopapilledema in children and should be interpreted in conjunction with other clinical findings.
评估口服荧光素血管造影（OFA）在鉴别儿童视乳头水肿与假性视乳头水肿中的准确性和安全性。
对一项诊断试验的回顾性评估。
我们回顾性分析了2018年5月至2021年8月期间就诊于阿肯色儿童医院、年龄≤18岁且疑似视盘（OD）肿胀并接受OFA检查及口服后30分钟以上图像的所有儿童的病历。两名盲法专家将图像解读为OD渗漏、无渗漏或临界渗漏。视盘肿胀根据弗里森分级量表（0 - 5级）进行临床分级。我们将OFA图像与最终临床诊断进行比较，并按如下方式计算试验的准确性：（正确识别为视乳头水肿的眼数[真阳性] + 正确识别为假性视乳头水肿的眼数[真阴性]）/（总眼数）×100%。
纳入45例患者（90只眼），其中11例为视乳头水肿，34例为假性视乳头水肿。平均年龄为14.1±3.5岁；66.7%为女性。审阅者1对OFA的准确性为62%，审阅者2为69%。未观察到OFA后有眼部或全身不良反应。两位审阅者在对OFA图像分级方面有高度一致性（k = 0.779）。
OFA不能明确区分儿童视乳头水肿与假性视乳头水肿，应结合其他临床发现进行解读。
