Pramil Varsha, Tam Mary, Vuong Laurel N, Hedges Thomas R
Tufts University School of Medicine, Boston, Massachusetts, USA.
New England Eye Center, Tufts New England Medical Center, Boston, Massachusetts, USA.
Neuroophthalmology. 2022 Sep 7;46(6):390-398. doi: 10.1080/01658107.2022.2116458. eCollection 2022.
An initial misdiagnosis of papilloedema in a patient with optic nerve head swelling can be anxiety-provoking and may result in unnecessary, invasive, and costly tests. Cirrus high definition, spectral domain-optical coherence tomography (Cirrus HD-OCT) may provide a rapid and non-invasive test. We sought to determine an upper limit of average retinal nerve fibre layer (RNFL) thickness in patients with pseudopapilloedema without visible drusen using Cirrus HD-OCT that could be utilised in conjunction with the clinical presentation and physical examination when managing patients with optic nerve head swelling. Inclusion criteria consisted of at least two neuro-ophthalmological visits and repeated imaging of the optic nerve head with Cirrus HD-OCT at least 6 months apart. Exclusion criteria included clinically visible drusen along with previous or concomitant diagnosis of retinal or other optic nerve pathology. Thirty-eight eyes from 19 patients with pseudopapilloedema were included in this study. The upper limit of average RNFL thickness was defined as two standard deviations above the mean of the average RNFL thickness and was calculated to be 158.65 µm for scans obtained with Cirrus HD-OCT devices. A patient with suspected optic nerve head swelling, an average RNFL thickness less than 158.65 µm, and no other evidence of papilloedema or neurological signs or symptoms can be managed with serial follow-ups with OCT imaging for at least 6 months. If the patient continues to have no clinical symptoms suggesting increased intracranial pressure and the average RNFL thickness is stable, the likelihood of papilloedema is minimal.
对于视神经乳头肿胀的患者，最初误诊为视乳头水肿可能会引发焦虑，并可能导致不必要的、侵入性的且昂贵的检查。Cirrus高分辨率、光谱域光学相干断层扫描（Cirrus HD-OCT）可能提供一种快速且非侵入性的检查方法。我们试图使用Cirrus HD-OCT确定无可见玻璃膜疣的假性视乳头水肿患者平均视网膜神经纤维层（RNFL）厚度的上限，该上限可在对视神经乳头肿胀患者进行管理时结合临床表现和体格检查加以利用。纳入标准包括至少两次神经眼科就诊以及至少间隔6个月用Cirrus HD-OCT对视神经乳头进行重复成像。排除标准包括临床上可见的玻璃膜疣以及既往或同时诊断的视网膜或其他视神经病变。本研究纳入了19例假性视乳头水肿患者的38只眼。平均RNFL厚度的上限定义为平均RNFL厚度均值以上两个标准差，经计算，使用Cirrus HD-OCT设备获得的扫描结果中该上限为158.65µm。对于疑似视神经乳头肿胀、平均RNFL厚度小于158.65µm且无其他视乳头水肿证据或神经体征或症状的患者，可通过至少6个月的OCT成像系列随访进行管理。如果患者持续没有提示颅内压升高的临床症状且平均RNFL厚度稳定，则视乳头水肿的可能性极小。
