Pandya Bhadra U, Jhaveri Aaditeya, Shamshad Farooq, Margolin Edward A, Micieli Jonathan A
Temerty Faculty of Medicine (BUP, AJ), University of Toronto, Toronto, Canada ; Faculty of Medicine (FS), University of Alberta, Edmonton, Canada; Department of Ophthalmology and Vision Sciences (EAM, JAM), Faculty of Medicine, University of Toronto, Toronto, Canada; and Kensington Vision and Research Centre (JAM), Toronto, Canada.
J Neuroophthalmol. 2024 Dec 1;44(4):478-482. doi: 10.1097/WNO.0000000000002030. Epub 2023 Nov 6.
To evaluate the most common causes of optic disc edema (ODE) in patients with significantly compromised vision (initial best-corrected visual acuity [BCVA] of 20/400 or worse) at presentation.
Retrospective chart review over a 5-year period of consecutive patients presenting to tertiary neuro-ophthalmology clinics at the University of Toronto.
A total of 656 patients with ODE were included, and 49 patients (7.47%) had an initial BCVA of 20/400 or worse. There were 54 eyes included at baseline and 49 eyes at final follow-up. There were 29 female and 20 male patients. The mean age at first visit across patients was 55.9 years. Female patients (n = 29) were significantly older than male patients (n = 20) ( P < 0.05). The causes of ODE were optic neuritis (ON) (n = 22; 40.7%), nonarteritic anterior ischemic optic neuropathy (NAION) (n = 22; 40.7%), arteritic anterior ischemic optic neuropathy (AAION) (n = 5; 9.26%), uveitis-related (n = 3; 5.56%), papilledema from idiopathic intracranial hypertension (IIH) (n = 1; 1.85%), and Vogt-Koyanagi-Harada disease (n = 1; 1.85%). Initial BCVA was not significantly different between ON and NAION groups ( P = 0.52); however, final BCVA was significantly better in the ON group ( P < 0.0001). The mean initial BCVA was worst in the AAION group (2.62 ± 0.54 logarithm of the minimum angle of resolution). The most common cause of ODE in patients <40 years old was ON (83.3%), whereas the 2 most common causes in patients >80 were NAION (60%) and AAION (40%). In patients between the ages of 60-80, NAION (100%) was the only cause.
Patients with ODE and poor vision at presentation represent a minority of cases seen in neuro-ophthalmology clinics (<10%). Optic neuritis and NAION are the 2 most common causes of ODE with poor vision at presentation. These findings are limited by a small sample size and potential sampling bias.
评估就诊时视力显著受损（初始最佳矫正视力[BCVA]为20/400或更差）患者视盘水肿（ODE）的最常见病因。
对多伦多大学三级神经眼科诊所连续5年就诊患者的病历进行回顾性分析。
共纳入656例ODE患者，49例（7.47%）初始BCVA为20/400或更差。基线时纳入54只眼，最终随访时为49只眼。有29例女性和20例男性患者。患者首次就诊时的平均年龄为55.9岁。女性患者（n = 29）明显比男性患者（n = 20）年龄大（P < 0.05）。ODE的病因包括视神经炎（ON）（n = 22；40.7%）、非动脉炎性前部缺血性视神经病变（NAION）（n = 22；40.7%）、动脉炎性前部缺血性视神经病变（AAION）（n = 5；9.26%）、葡萄膜炎相关（n = 3；5.56%）、特发性颅内高压（IIH）所致视乳头水肿（n = 1；1.85%）和Vogt - 小柳 - 原田病（n = 1；1.85%）。ON组和NAION组的初始BCVA无显著差异（P = 0.52）；然而，ON组的最终BCVA明显更好（P < 0.0001）。AAION组的平均初始BCVA最差（最小分辨角对数为2.62 ± 0.54）。40岁以下患者ODE最常见的病因是ON（83.3%），而80岁以上患者最常见的2种病因是NAION（60%）和AAION（40%）。在60 - 80岁的患者中，NAION（100%）是唯一病因。
就诊时患有ODE且视力差的患者占神经眼科诊所所见病例的少数（<10%）。视神经炎和NAION是就诊时视力差的ODE的2种最常见病因。这些发现受样本量小和潜在抽样偏倚的限制。
