Optical Coherence Tomography Neuro-Toolbox for the Diagnosis and Management of Papilledema, Optic Disc Edema, and Pseudopapilledema.
Optical Coherence Tomography Neuro-Toolbox for the Diagnosis and Management of Papilledema, Optic Disc Edema, and Pseudopapilledema.
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DOI：
10.1097/wno.0000000000001078
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发表时间：
2021-03-01
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影响因子：
--
通讯作者：
Kardon RH
中科院分区：
文献类型：
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作者：
Sibony PA;Kupersmith MJ;Kardon RH
补充数字内容可在文本中获得。区分视盘水肿和假乳头水肿是一个常见的，有时具有挑战性的临床问题。视神经头（ONH）的光谱域光学相干断层扫描（SD-OCT）的进展已被证明是一种经济有效、无创的门诊手术。其核心是量化视网膜神经纤维层（RNFL）和神经节细胞-内丛状层（GC-IPL）厚度的工具。SD-OCT还提供了一套工具，可以像我们读取MRI一样进行定性解释。它们包括横轴、平面和圆形层析成像。我们的目标是描述一套实用的基于办公室的工具，使用SD-OCT诊断和监测乳头水肿、视盘水肿和假性乳头水肿。使用以下关键词组合在PubMed上进行搜索：OCT、乳头水肿、假性乳头水肿、视盘水肿、视网膜褶皱（RF）和脉络膜褶皱（CF）。SD-OCT分析ONH的主要元素是RNFL和GC-IPL厚度;然而，当肿胀严重时，这些指标有局限性。横向轴向SD-OCT的定性解释有助于评估乳头周围形状，这可能有助于区分乳头水肿和假性乳头水肿，评估非典型视神经病变，诊断分流失败，并识别外部RF和CF。一致认为SD-OCT是识别隐藏视盘囊肿最敏感的方法。面部SD-OCT在检测乳头周围皱纹和视网膜外皱纹方面特别有效，这两种皱纹都是视盘水肿的常见和独特的迹象，可以排除假性乳头水肿。在患有乳头水肿的患者中，机械地对内收眼位的ONH施加压力，可能会暴露出原发位置不明显的褶皱和乳头周围变形。我们还讨论了如何优化SD-OCT图像的获取和配准。SD-OCT不能代替完整的病史和仔细的检查。然而，它是一种方便的辅助测试，有助于诊断和治疗乳头水肿、视盘水肿和假性乳头水肿。它特别有助于监测随时间的变化和区分低度乳头水肿和埋藏性水肿。SD-OCT工具箱的应用取决于优化图像采集，了解其局限性，识别常见的假影，并在病史和临床表现的背景下准确解释图像。
Supplemental Digital Content is Available in the Text. Distinguishing optic disc edema from pseudopapilledema is a common, sometimes challenging clinical problem. Advances in spectral-domain optical coherence tomography (SD-OCT) of the optic nerve head (ONH) has proven to be a cost effective, noninvasive, outpatient procedure that may help. At its core are tools that quantify the thickness of the retinal nerve fiber layer (RNFL) and ganglion cell–inner plexiform layer (GC-IPL). The SD-OCT also provides a set of tools that may be qualitatively interpreted in the same way that we read an MRI. They include the transverse axial, en face, and circular tomogram. Our goal is to describe a practical office-based set of tools using SD-OCT in the diagnosis and monitoring of papilledema, optic disc edema, and pseudopapilledema. Searches on PubMed were performed using combinations of the following key words: OCT, papilledema, pseudopapilledema, optic disc drusen, retinal folds (RF), and choroidal folds (CF). The principal elements of SD-OCT analysis of the ONH are the RNFL and GC-IPL thickness; however, these metrics have limitations when swelling is severe. Qualitative interpretation of the transverse axial SD-OCT aids in assessing peripapillary shape that may help distinguish papilledema from pseudopapilledema, evaluate atypical optic neuropathies, diagnose shunt failures, and identify outer RF and CF. There is a consensus that the SD-OCT is the most sensitive way of identifying buried optic disc drusen. En face SD-OCT is especially effective at detecting peripapillary wrinkles and outer retinal creases, both of which are common and distinctive signs of optic disc edema that rule out pseudopapilledema. Mechanically stressing the ONH in the adducted eye position, in patients with papilledema, may expose folds and peripapillary deformations that may not be evident in primary position. We also discuss how to optimize the acquisition and registration of SD-OCT images. The SD-OCT is not a substitute for a complete history and a careful examination. It is, however, a convenient ancillary test that aids in the diagnosis and management of papilledema, optic disc edema, and pseudopapilledema. It is particularly helpful in monitoring changes over the course of time and distinguishing low-grade papilledema from buried drusen. The application of the SD-OCT toolbox depends on optimizing the acquisition of images, understanding its limitations, recognizing common artifacts, and accurately interpreting images in the context of both history and clinical findings.