Iritas Ilter, Ozer Pinar A, Sel Çiğdem Genç
Ophthalmology, Pendik State Hospital Istanbul, Turkey.
Prof of Ophthalmology, Private Practice, Ankara, Turkey.
Photodiagnosis Photodyn Ther. 2024 Dec;50:104367. doi: 10.1016/j.pdpdt.2024.104367. Epub 2024 Oct 12.
To investigate some diagnostic indicators in optic nerve head (ONH) analysis of children with 'Pseudopapilledema' and 'Papilledema' by Spectral Domain Optical Coherence Tomography (SD-OCT).
Medical records of 52 children with optic disc swelling, who were followed up by the departments of pediatric neurology and ophthalmology between May 2018 and May 2019 were reviewed retrospectively. Cases were classified as group 1 (Papilledema secondary to Idiopathic Intracranial Hypertension) including 54 eyes of 27 cases, group 2 (Pseudopapilledema secondary to bilateral optic disc drusen) including 50 eyes of 25 cases and control group. Three-dimensional imaging of ONH, peripapillary retinal nerve fiber layer (RNLF) thickness, Bruch's membrane opening height in the nasal respectively temporal quadrant (BMHN, BMH-T) levels were measured by SD-OCT and B-mode ocular ultrasonography data of all cases were evaluated.
When RNFL levels were compared between groups, nasal RNFL levels were found to be significantly higher in group 1 cases compared to group 2 (p < 0.001). In 3D imaging of the ONH among group 1 patients, the mean height of the apex in disc swelling was significantly higher than that of group 2 (p = 0,024). The apex in disc swelling was mostly observed to be localized at the middle and had a diffuse swelling pattern in group 1; whereas, in group 2, the it was localized mostly at the nasal quadrant. This variation was statistically significant (p < 0.001). When, Bruch's membrane opening height in the nasal respectively temporal quadrant (BMHN, BMH-T) levels were compared, the measurements obtained were found to be significantly higher in group 1 (p = 0,050 and p = 0,003 respectively).
Nasal RNFL values of SD-OCT, Bruch's membrane opening height in the nasal respectively temporal quadrant (BMHN, BMH-T) levels, the location of the apex in disc swelling obtained by 3D analysis of the ONH are found to be potential diagnostic parameters when combined with clinical findings. It is important that the nasal quadrant elevation, where the highest peak in 3D imaging was measured, was higher in the papilledema group. The elevation of the optic disc peak in 3D imaging can be used as a parameter to help clinicians distinguish between optic disc drusen (ODD) and papilledema.
通过频域光学相干断层扫描（SD-OCT）研究“假性视乳头水肿”和“视乳头水肿”患儿视神经乳头（ONH）分析中的一些诊断指标。
回顾性分析2018年5月至2019年5月期间在儿科神经科和眼科随访的52例视盘肿胀患儿的病历。病例分为1组（特发性颅内高压继发视乳头水肿），包括27例54只眼；2组（双侧视盘玻璃疣继发假性视乳头水肿），包括25例50只眼，以及对照组。通过SD-OCT测量ONH的三维成像、视乳头周围视网膜神经纤维层（RNLF）厚度、鼻侧和颞侧象限的布鲁赫膜开口高度（BMHN、BMH-T），并评估所有病例的B型眼部超声数据。
比较各组间RNFL水平时，发现1组病例的鼻侧RNFL水平显著高于2组（p < 0.001）。在1组患者的ONH三维成像中，视盘肿胀处顶点的平均高度显著高于2组（p = 0.024）。1组中视盘肿胀处顶点大多位于中部，呈弥漫性肿胀模式；而在2组中，大多位于鼻侧象限。这种差异具有统计学意义（p < 0.001）。比较鼻侧和颞侧象限的布鲁赫膜开口高度（BMHN、BMH-T）水平时，发现1组的测量值显著更高（分别为p = 0.050和p = 0.003）。
SD-OCT的鼻侧RNFL值、鼻侧和颞侧象限的布鲁赫膜开口高度（BMHN、BMH-T）水平、通过ONH三维分析获得的视盘肿胀处顶点位置，与临床发现相结合时，被发现是潜在的诊断参数。重要的是，视乳头水肿组中测量到三维成像最高峰的鼻侧象限抬高更高。三维成像中视盘峰值的抬高可作为帮助临床医生区分视盘玻璃疣（ODD）和视乳头水肿的参数。
