Use of A-scan Ultrasound and Optical Coherence Tomography to Differentiate Papilledema From Pseudopapilledema
| Autor: | Roberto Saenz, Rosa A. Tang, Laura J. Frishman, Han Cheng, Thomas C. Prager |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Adult
Male Retinal Ganglion Cells medicine.medical_specialty Materials science genetic structures Optic Disk Optic disk Nerve fiber layer Drusen Article Diagnosis Differential 03 medical and health sciences chemistry.chemical_compound Nerve Fibers 0302 clinical medicine Optical coherence tomography Ophthalmology Optic Nerve Diseases medicine Humans Papilledema Retrospective Studies Ultrasonography Pseudopapilledema medicine.diagnostic_test Eye Diseases Hereditary Retinal medicine.disease eye diseases Cross-Sectional Studies medicine.anatomical_structure ROC Curve chemistry 030221 ophthalmology & optometry Female sense organs Tomography medicine.symptom Tomography Optical Coherence 030217 neurology & neurosurgery Optometry |
| Zdroj: | Optometry and Vision Science. 94:1081-1089 |
| ISSN: | 1538-9235 1040-5488 |
| Popis: | Differentiating papilledema from pseudopapilledema reflecting tilted/crowded optic discs or disc drusen is critical but can be challenging. Our study suggests that spectral-domain optical coherence tomography (OCT) peripapillary retinal nerve fiber layer thickness and retrobulbar optic nerve sheath diameter (ONSD) measured by A-scan ultrasound provide useful information when differentiating the two conditions.To evaluate the use of A-scan ultrasound and spectral-domain OCT retinal nerve fiber layer thickness (RNFLT) in differentiating papilledema associated with idiopathic intracranial hypertension from pseudopapilledema.Retrospective cross-sectional analysis included 23 papilledema and 28 pseudopapilledema patients. Ultrasound-measured ONSD at primary gaze, percent change in ONSD at lateral gaze (30° test), and peripapillary RNFLT were analyzed. Receiver operating characteristic curves were constructed using one eye from each subject.Compared with pseudopapilledema, papilledema eyes showed larger mean ONSD (5.4 ± 0.6 vs. 4.0 ± 0.3 mm, P.0001), greater change of ONSD at lateral gaze (22.4 ± 8.4% vs. 2.8 ± 4.8%, P.0001), and thicker retinal nerve fiber layer (219.1 ± 104.6 vs. 102.4 ± 20.1 μm, P.0001). Optic nerve sheath diameter and 30° test had the greatest area under the receiver operating characteristic curve, 0.98 and 0.97, respectively; followed by inferior quadrant (0.90) and average RNFLT (0.87). All papilledema eyes with Frisén scale greater than grade II were accurately diagnosed by ONSD, 30° test, or OCT. In mild papilledema (Frisén scale grades I and II, n = 15), area under the receiver operating characteristic curve remained high for ONSD (0.95) and 30° test (0.93) but decreased to 0.61 to 0.71 for RNFLT. At 95% specificity, sensitivities for ONSD, 30° test, and RNFLT were 91.3%, 91.3%, and 56.5%, respectively, for the entire papilledema group and 80.0%, 86.7%, and 13.3% for the mild papilledema subgroup.Retinal nerve fiber layer thickness can potentially be used to detect moderate to severe papilledema. A-scan may further assist differentiation of mild papilledema from pseudopapilledema. |
| Databáze: | OpenAIRE |
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