Optical Coherence Tomography in Papilledema: What Am I Missing?
Optical Coherence Tomography in Papilledema: What Am I Missing?
复制标题
DOI：
10.1097/wno.0000000000000162
复制
发表时间：
2014-09-01
影响因子：
2.9
通讯作者：
Kardon, Randy
中科院分区：
文献类型：
--
作者：
Kardon, Randy
背景：视神经乳头水肿的严重程度分级是主观的，基于单眼眼底的视神经特征。即使使用明确定义的标准（如Frisen量表，这是一种非连续的顺序分级量表），专家观察者之间对视神经乳头水肿严重程度分级的一致性也很差。此外，非专业的临床医生经常发现难以使用检眼镜检查正确地观察和解释视神经的特征，这可能导致在非眼科护理环境中无法诊断视乳头水肿。这可能会延迟治疗，从而导致视力丧失。当表面玻璃疣不容易识别时，区分视乳头水肿和假视乳头水肿也很困难。一旦诊断出视神经乳头水肿，通常很难确定视神经水肿的减少是否仅仅是由于神经状态的改善，或者这是否代表轴突和存活的视网膜神经节细胞的伴随损失，导致视力不良。如果在早期评估阶段能够诊断出神经元丢失，而视盘水肿仍然存在，则治疗将及时推进。这篇综述将严格评估光学相干断层扫描（OCT）在解决这些问题中的作用，通过提供一种先进的成像方法来诊断视神经乳头水肿，并在连续的尺度上评估其严重程度，并评估在神经肿胀的情况下视力丧失的原因。对2000年至2014年期间发表的文献（PubMed）进行了综述，内容涉及使用OCT诊断视乳头水肿，将其与假性视乳头水肿区分开来，结果：最近的证据表明，OCT分析的视网膜神经纤维层和视网膜神经节细胞层的视乳头水肿可以与误导性的文物，由于层分割故障。使用邻近位置的较新3D算法有助于克服这些问题。椎间盘体积似乎是一个有前途的视神经乳头水肿的连续测量，是强大的，并有较少的相关文物。埋藏性视盘玻璃疣可以使用增强深度OCT成像来识别，但最近的研究表明，当视盘评估程度相似时，使用OCT区分视乳头水肿和假性视乳头水肿的能力较差。对视网膜神经节细胞层的分析显示了早期检测由于神经元损伤导致的视力丧失的希望。视网膜下液很容易用OCT识别，可以帮助识别视力丧失的潜在可逆成分。较新的OCT成像方法将允许毛细血管的定义和流动，他们在和周围的视神经head.Conclusions：目前，最有用的OCT衍生功能相关的视乳头水肿是光盘体积，视网膜下液，埋藏盘玻璃疣，视网膜神经节细胞层的厚度。
Background:Grading of papilledema severity is subjective and based on monocular fundus features of the optic nerve. Interobserver agreement on grading the severity of papilledema is poor among expert observers, even using well-defined criteria such as the Frisen scale, which is a non-continuous ordinal scale of grading. Furthermore, non-expert clinicians often find it difficult to properly view and interpret features of the optic nerve using ophthalmoscopy, which can lead to failure to diagnose papilledema in non-ophthalmologic care settings. This may delay treatment, which can result in vision loss. Distinguishing papilledema from pseudopapilledema can also be difficult when surface drusen are not easily identified. Once papilledema is diagnosed, it is often difficult to determine whether a reduction in optic nerve edema is due solely to improvement in the status of the nerve or whether this represents concomitant loss of axons and viable retinal ganglion cells, leading to a poor visual outcome. Timely advancement of treatment would occur if loss of neurons could be diagnosed at an earlier stage of evaluation while optic disc edema is still present. This review will critically assess the role of optical coherence tomography (OCT) in solving these problems by providing an advanced imaging approach for diagnosis of papilledema and evaluating its severity on a continuous scale and evaluating the causes of visual loss in the setting of a swollen nerve.Methods Acquisition:The published literature (PubMed) was reviewed from 2000 to 2014 on the use of OCT for diagnosing papilledema, differentiating it from pseudopapilledema, providing a continuous scale of its severity and in evaluating causes of visual loss.Results:Recent evidence shows that OCT analysis of the retinal nerve fiber layer and retinal ganglion cell layer in papilledema can be associated with misleading artifacts due to layer segmentation failures. Newer 3D algorithms using neighboring locations help to overcome these problems. Disc volume appears to be a promising continuous measure of papilledema that is robust and has less associated artifacts. Buried optic disc drusen can be identified using enhanced depth OCT imaging, but recent studies have shown poor ability to differentiate papilledema from pseudopapilledema using OCT when the degree of disc evaluation is similar. Analysis of the retinal ganglion cell layer shows promise of early detection of vision loss due to neuronal injury. Subretinal fluid is easily identified with OCT and can help to identify a potentially reversible component of vision loss. Newer OCT imaging methods will allow the definition of capillaries and flow within them in and around the optic nerve head.Conclusions:Currently, the most useful OCT derived features relevant to papilledema are disc volume, subretinal fluid, buried disc drusen, and thickness of the retinal ganglion cell layer.