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Chang MY, Heidary G, Beres S, Pineles SL, Gaier ED, Gise R, Reid M, Avramidis K, Rostami M, Narayanan S. Artificial Intelligence to Differentiate Pediatric Pseudopapilledema and True Papilledema on Fundus Photographs. OPHTHALMOLOGY SCIENCE 2024; 4:100496. [PMID: 38682028 PMCID: PMC11046195 DOI: 10.1016/j.xops.2024.100496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 02/14/2024] [Accepted: 02/15/2024] [Indexed: 05/01/2024]
Abstract
Purpose To develop and test an artificial intelligence (AI) model to aid in differentiating pediatric pseudopapilledema from true papilledema on fundus photographs. Design Multicenter retrospective study. Subjects A total of 851 fundus photographs from 235 children (age < 18 years) with pseudopapilledema and true papilledema. Methods Four pediatric neuro-ophthalmologists at 4 different institutions contributed fundus photographs of children with confirmed diagnoses of papilledema or pseudopapilledema. An AI model to classify fundus photographs as papilledema or pseudopapilledema was developed using a DenseNet backbone and a tribranch convolutional neural network. We performed 10-fold cross-validation and separately analyzed an external test set. The AI model's performance was compared with 2 masked human expert pediatric neuro-ophthalmologists, who performed the same classification task. Main Outcome Measures Accuracy, sensitivity, and specificity of the AI model compared with human experts. Results The area under receiver operating curve of the AI model was 0.77 for the cross-validation set and 0.81 for the external test set. The accuracy of the AI model was 70.0% for the cross-validation set and 73.9% for the external test set. The sensitivity of the AI model was 73.4% for the cross-validation set and 90.4% for the external test set. The AI model's accuracy was significantly higher than human experts on the cross validation set (P < 0.002), and the model's sensitivity was significantly higher on the external test set (P = 0.0002). The specificity of the AI model and human experts was similar (56.4%-67.3%). Moreover, the AI model was significantly more sensitive at detecting mild papilledema than human experts, whereas AI and humans performed similarly on photographs of moderate-to-severe papilledema. On review of the external test set, only 1 child (with nearly resolved pseudotumor cerebri) had both eyes with papilledema incorrectly classified as pseudopapilledema. Conclusions When classifying fundus photographs of pediatric papilledema and pseudopapilledema, our AI model achieved > 90% sensitivity at detecting papilledema, superior to human experts. Due to the high sensitivity and low false negative rate, AI may be useful to triage children with suspected papilledema requiring work-up to evaluate for serious underlying neurologic conditions. Financial Disclosures Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Melinda Y. Chang
- Division of Ophthalmology, Children’s Hospital Los Angeles, Los Angeles, California
- Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Gena Heidary
- Department of Ophthalmology, Boston Children’s Hospital, Boston, Massachusetts
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
| | - Shannon Beres
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California
| | - Stacy L. Pineles
- Department of Ophthalmology, Stein Eye Institute, University of California, Los Angeles, Los Angeles, California
| | - Eric D. Gaier
- Department of Ophthalmology, Boston Children’s Hospital, Boston, Massachusetts
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
- Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Ryan Gise
- Department of Ophthalmology, Boston Children’s Hospital, Boston, Massachusetts
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
| | - Mark Reid
- Division of Ophthalmology, Children’s Hospital Los Angeles, Los Angeles, California
| | - Kleanthis Avramidis
- Viterbi School of Engineering, University of Southern California, Los Angeles, California
| | - Mohammad Rostami
- Viterbi School of Engineering, University of Southern California, Los Angeles, California
- Information Sciences Institute, University of Southern California, Los Angeles, California
| | - Shrikanth Narayanan
- Viterbi School of Engineering, University of Southern California, Los Angeles, California
- Information Sciences Institute, University of Southern California, Los Angeles, California
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Bentin JM, Heegaard S, Jørgensen NR, Grahnemo L, Hamann S. Optic disc drusen: Dystrophic calcification, a potential target for treatment. Eye (Lond) 2024:10.1038/s41433-024-03138-6. [PMID: 38778137 DOI: 10.1038/s41433-024-03138-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 04/05/2024] [Accepted: 05/07/2024] [Indexed: 05/25/2024] Open
Abstract
Optic disc drusen (ODD) are calcified, acellular bodies, seen in the optic nerve head of up to 2% of the population. Although seldomly affecting visual acuity, visual field defects are common, and severe, ischemic complications causing irreversible vision loss are known to occur. Different treatment strategies for ODD have been explored, but so far without success. This review focuses on the unique, calcified property of ODD, describing what we know about ODD pathogenesis and previously tried treatment strategies. In this context, we discuss current knowledge about calcium and pathological calcifications, including intracranial and ocular calcifications. We also explore some of the obstacles that must be addressed to develop a therapy centred on the concept of calcification, should calcification be identified as a pathogenic factor contributing to vision loss.
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Affiliation(s)
- Josephine Mejdahl Bentin
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark
| | - Steffen Heegaard
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Niklas Rye Jørgensen
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Translational Research Centre, Rigshospitalet, Copenhagen, Denmark
| | - Louise Grahnemo
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Osteoporosis Centre, Centre for Bone and Arthritis Research at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Steffen Hamann
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark.
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
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Gerrie SK, Rajani H, Branson HM, Lyons CJ, Marie E, Frayn CS, Hughes ECM, Navarro OM. Pediatric orbital lesions: ocular pathologies. Pediatr Radiol 2024; 54:876-896. [PMID: 38321238 DOI: 10.1007/s00247-024-05869-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/19/2024] [Accepted: 01/23/2024] [Indexed: 02/08/2024]
Abstract
Orbital pathologies can be broadly classified as ocular, extra-ocular soft-tissue (non-neoplastic and neoplastic), osseous, and traumatic. In part 1 of this orbital series, the authors will discuss the differential diagnosis and key imaging features of pediatric ocular pathologies. These include congenital and developmental lesions (microphthalmos, anophthalmos, persistent fetal vasculature, coloboma, morning glory disc anomaly, retinopathy of prematurity, Coats disease), optic disc drusen, infective and inflammatory lesions (uveitis, toxocariasis, toxoplasmosis), and ocular neoplasms (retinoblastoma, retinal hamartoma, choroidal melanoma, choroidal nevus). This pictorial review provides a practical approach to the imaging work-up of these anomalies with a focus on ocular US as the first imaging modality and additional use of CT and/or MRI for the evaluation of intracranial abnormalities. The characteristic imaging features of the non-neoplastic mimics of retinoblastoma, such as persistent fetal vasculature and Coats disease, are also highlighted.
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Affiliation(s)
- Samantha K Gerrie
- Department of Radiology, BC Children's Hospital, 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada.
- Department of Radiology, University of British Columbia, Vancouver, Canada.
| | - Heena Rajani
- Department of Radiology, BC Children's Hospital, 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
- Department of Radiology, University of British Columbia, Vancouver, Canada
| | - Helen M Branson
- Department of Diagnostic and Interventional Radiology, The Hospital for Sick Children, Toronto, Canada
- Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Christopher J Lyons
- Department of Ophthalmology, BC Children's Hospital, Vancouver, Canada
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, Canada
| | - Eman Marie
- Department of Diagnostic Imaging, McMaster Children's Hospital, McMaster University, Hamilton, Canada
| | - Cassidy S Frayn
- Department of Radiology, BC Children's Hospital, 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
- Department of Radiology, University of British Columbia, Vancouver, Canada
| | - Emily C M Hughes
- Department of Radiology, BC Children's Hospital, 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
- Department of Radiology, University of British Columbia, Vancouver, Canada
| | - Oscar M Navarro
- Department of Diagnostic and Interventional Radiology, The Hospital for Sick Children, Toronto, Canada
- Department of Medical Imaging, University of Toronto, Toronto, Canada
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Lopez JM, Rabinovich M, Mehanna CJ, Ricciotti G, Crincoli E, Semoun O, Miere A, Souied EH. Retro-mode imaging for the diagnosis of optic disc drusen: a case series. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2024; 99:187-194. [PMID: 38342229 DOI: 10.1016/j.oftale.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 12/23/2023] [Indexed: 02/13/2024]
Abstract
OBJECTIVE We aimed to compare the detectability of optic disc drusen (ODD), using various non-invasive imaging techniques, including the novel retro-mode imaging (RMI), as well as to analyze the morphological characteristics of ODD on RMI. METHODS This study involved seven patients with bilateral ODD, totaling 14 eyes. Multimodal imaging techniques, including multicolor fundus photography (MC), near-infrared reflectance (NIR), green and blue light fundus autofluorescence (G-FAF and B-FAF, respectively), and RMI were used to examine the eyes. FAF was used as the primary method of identifying ODD, and each method's detection rate was compared by two observers. Quantitative measurements of ODD included the number of ODD visualized by the RMI technique, the perimeter (P) and area (A) of ODD were identified. RESULTS The average age of the patients included was 49.28 ± 23.16 years, with five of the seven being men. RMI was able to detect ODD in all cases, with a sensitivity of 100%, compared to MC (sensitivity 60.71%), NIR (sensitivity 60.71%), B-FAF (sensitivity 100%), G-FAF (sensitivity 100%). RMI was the only imaging technique capable of assessing ODD morphology and quantifying ODD. CONCLUSIONS RMI is a promising imaging modality for diagnosing superficial ODD, providing valuable information on the distribution, location, and size of ODD. We suggest the incorporation of RMI as a complementary tool for diagnosing and monitoring ODD in combination with other multimodal imaging methods.
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Affiliation(s)
- J M Lopez
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Créteil, France; Institut Català de Retina, Barcelona, Spain.
| | - M Rabinovich
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - C-J Mehanna
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - G Ricciotti
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - E Crincoli
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - O Semoun
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - A Miere
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - E H Souied
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Créteil, France
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Yalcinkaya Cakir G, Solmaz B, Cakir I, Pasaoglu IB, Taskapili M. Optical coherence tomography angiography findings in optic disc drusen and idiopathic intracranial hypertension. Eur J Ophthalmol 2024; 34:566-573. [PMID: 37424290 DOI: 10.1177/11206721231187664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
PURPOSE To evaluate the changes in peripapillary microvascularity in idiopathic intracranial hypertension (IIH) and optic disc drusen (ODD) patients, by comparing them with those in healthy individuals, via optical coherence tomography angiography (OCTA). METHODS Sixty-two eyes of 33 patients with ODD, 58 eyes of 30 patients with IIH, and 70 eyes of 70 healthy people were imaged for 6 × 6-mm optic disc scans on a spectral-domain OCTA. Vascular densities in superficial capillary plexus (SCP), deep capillary plexus (DCP), and choriocapillaris (CC) of ODD, IIH, and healthy eyes were compared with a one-way analysis of variance. Post-hoc analysis was performed with the Gabriel test. RESULTS There was a significant decrease in peripapillary vessel density in SCP, DCP, and CC in patients with IIH compared to the control group (p < 0.05). In ODD patients, especially peripapillary vessel density in DCP was significantly reduced compared to the control group (p < 0.05). Peripapillary vessel density in DCP was significantly lower in the IIH group than ODD group (p < 0.05). CONCLUSIONS Peripapillary vascular density may be affected during the course of the disease in both IIH and ODD. Compared to healthy individuals, the decrease in vascular density in these patients and the consequent decrease in perfusion in the peripapillary region may guide the pathogenesis of the complications in the course of these two diseases. Although vascular density in DCP and CC differs significantly between IIH and ODD, case-controlled studies are needed to evaluate the role of OCTA in the differential diagnosis of IHH and ODD.
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Affiliation(s)
| | - Banu Solmaz
- Faculty of Medicine, Ophthalmology Department, Medipol University, Istanbul, Turkey
| | - Ihsan Cakir
- Beyoglu Eye Training and Research Hospital, University of Health Sciences Turkey, Istanbul, Turkey
| | - Isil Basgil Pasaoglu
- Beyoglu Eye Training and Research Hospital, University of Health Sciences Turkey, Istanbul, Turkey
| | - Muhittin Taskapili
- Beyoglu Eye Training and Research Hospital, University of Health Sciences Turkey, Istanbul, Turkey
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Tavakoli M, Yan F, Tauscher R. Concomitant optic disk drusen and papilledema due to idiopathic intracranial hypertension in a pediatric cohort. J AAPOS 2024; 28:103806. [PMID: 38216114 DOI: 10.1016/j.jaapos.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/30/2023] [Accepted: 11/06/2023] [Indexed: 01/14/2024]
Abstract
BACKGROUND Optic disk drusen (ODD) in pediatric patients typically presents with pseudopapilledema. Diagnosing concomitant papilledema due to idiopathic intracranial hypertension (IIH) in these patients can be challenging. The purpose of this study was to evaluate the incidence and clinical features of papilledema due to IIH among pediatric patients with a new diagnosis of ODD and to discuss the clinical and paraclinical findings that helped diagnose this group. METHODS The medical records of children <15 years of age with ODD confirmed by B-scan ultrasound at their first visit over a 4-year period (2019-2022) were reviewed retrospectively. Patients with concurrent IIH were identified, and the demographic and clinical characteristics were reviewed. RESULTS A total of 83 children with confirmed ODD at the initial presentation were included, of whom 4 (4.8%) were diagnosed with concomitant IIH. Patients ranged in age from 7 to 15 years; 3 of the 4 were female, and 3 had IIH-related symptoms at presentation (1 was asymptomatic). None of the 4 patients had papilledema greater than Frisen grade 2. CONCLUSIONS We recommend that clinicians review pertinent IIH symptoms and risk factors in children with ODD and follow the standard workup for IIH in suspicious cases. In asymptomatic patients with a new diagnosis of ODD, we recommend obtaining a follow-up optic nerve evaluation and optical coherence tomography scan to detect any significant interval change that might serve as a possible indicator of concomitant papilledema.
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Affiliation(s)
- Mehdi Tavakoli
- Department of Ophthalmology, The George Washington University School of Medicine and Health Sciences, Washington DC; Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama.
| | - Florence Yan
- Department of Ophthalmology, The George Washington University School of Medicine and Health Sciences, Washington DC
| | - Robert Tauscher
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama
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Bassi ST, Pamu R, Varghese A. Understanding pseudopapilledema on spectral domain optical coherence tomography. Indian J Ophthalmol 2023; 71:3552-3557. [PMID: 37870023 PMCID: PMC10752308 DOI: 10.4103/ijo.ijo_3146_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 05/29/2023] [Accepted: 06/17/2023] [Indexed: 10/24/2023] Open
Abstract
Purpose Optic nerve head drusen (ONHD), peripapillary hyperreflective ovoid mass-like structures (PHOMS), and horizontal hyperreflective lines (HHL) are commonly seen in eyes with pseudopapilledema on enhanced depth imaging (EDI) spectral domain optical coherence tomography (SDOCT). The objective of this study is to assess the frequency of ONHD, PHOMS, and HHL on spectral domain OCT in the eyes diagnosed to have pseudopapilledema. Methods A retrospective case-control study included patients diagnosed as pseudopapilledema and had EDI SD OCT imaging of the optic nerve head (n = 48 eyes) and controls (n = 20 eyes). OCT scans through the optic nerve head were studied to diagnose ONHD, HHL, and PHOMS. One proportion z test was used to find the difference in proportions. Results Forty eight eyes of 27 subjects were studied. ONHD as described by the optic disc drusen Studies consortium was noted in 19 eyes (39.48%), P value-0.032, PHOMS in 31 eyes (64.6%), P value 0.043, HL in 19 eyes (39.48%), P value 0.032, and none of the normals had ONHD, PHOMS, and HHL. Conclusions PHOMS are more frequently seen than ONHD and HHL in eyes with pseudopapilledema.
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Affiliation(s)
- Shikha Talwar Bassi
- Neuroophthalmology Services, Sankara Nethralaya, 18 College Road, Chennai, Tamil Nadu, India
| | - Ramesh Pamu
- Comprehensive Ophthalmology, Neuroophthalmology Services, Sankara Nethralaya, 18 College Road, Chennai, Tamil Nadu, India
| | - Anjaly Varghese
- Department of Optometry, Sankara Nethralaya, 18 College Road, Chennai, Tamil Nadu, India
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Kaplan AT, Öskan Yalçın S, Sağer SG. Clinical Findings and Optical Coherence Tomography Measurements of Pediatric Patients with Papilledema and Pseudopapilledema. Turk J Ophthalmol 2023; 53:294-300. [PMID: 37868142 PMCID: PMC10599342 DOI: 10.4274/tjo.galenos.2023.81504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 02/15/2023] [Indexed: 10/24/2023] Open
Abstract
Objectives To compare the clinical findings and multimodal imaging of pediatric patients diagnosed with papilledema and pseudopapilledema with those of healthy individuals. Materials and Methods Ninety children (<18 years of age) referred for suspected papilledema were included in this study. All patients underwent optical coherence tomography (OCT) imaging and were compared with normal control subjects. Results Fifty-eight children diagnosed with pseudopapilledema, 32 children with mild-to-moderate papilledema, and 40 controls were evaluated. The average and all quadrants of retinal nerve fiber layer (RNFL) thickness were significantly higher in the papilledema group than in the pseudopapilledema and control groups (p<0.001). Bruch's membrane opening (BMO) measurements were similar in both groups (p>0.05). The average, nasal, and temporal RNFL thicknesses were significantly higher in the pseudopapilledema group compared with the controls (p<0.001). Area under the receiver operating characteristic (ROC) curve showed high diagnostic ability for RNFL thickness in all quadrants to differentiate papilledema from pseudopapilledema (p<0.001). In the pseudopapilledema group, average, temporal, and inferior RNFL thickness and BMO measurements were significantly higher in eyes with optic nerve head drusen (n=28) compared with those without drusen (n=88) (p=0.035, p=0.022, p=0.040 and, p=0.047 respectively). Conclusion Papilledema and pseudopapilledema show great differences in evaluation, follow-up, and prognosis. Using non-invasive methods such as newly developed OCT techniques in differential diagnosis can relieve patients with pseudopapilledema from the stress and financial burden of expensive, extensive, and invasive procedures.
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Affiliation(s)
- Ayşin Tuba Kaplan
- University of Health Sciences Türkiye, Kartal Dr. Lütfi Kırdar City Hospital, Clinic of Ophthalmology, İstanbul, Türkiye
| | - Sibel Öskan Yalçın
- University of Health Sciences Türkiye, Kartal Dr. Lütfi Kırdar City Hospital, Clinic of Ophthalmology, İstanbul, Türkiye
| | - Safiye Güneş Sağer
- University of Health Sciences Türkiye, Kartal Dr. Lütfi Kırdar City Hospital, Clinic of Pediatric Neurology, İstanbul, Türkiye
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Kaya P, Özdemir Yalçınsoy K, Özdamar Erol Y. The Presence of Optic Disc Drusen in Eyes with Uveitis. Ocul Immunol Inflamm 2023; 31:1700-1706. [PMID: 37068199 DOI: 10.1080/09273948.2023.2193843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 03/16/2023] [Indexed: 04/19/2023]
Abstract
PURPOSE To evaluate the coexistence of optic disc drusen (ODD) in eyes with uveitis. METHODS In this retrospective, observational study, patients followed up in a uvea clinic with all types of uveitis were evaluated. ODD were confirmed by ocular ultrasonography, optic nerve head enhanced-depth imaging optical coherence tomography, fundus autofluorescence, and fundus photography. RESULTS ODD were detected in 17 of 545 (3.1%) uveitis patients. The mean age was 18.9 ± 10.4 years, and 76.5% were female. 45.5% were anterior, 42.4% were panuveitis, 6.1% were intermediate, and 6.1% were posterior uveitis. ODD were found bilaterally in all 17 patients; uveitis was unilateral in one patient. 58.8% were under the age of 18, and in this group, the rate of buried ODD was 78.9% (p = 0.039). In adults (seven patients), ODD were buried in 42.9%. CONCLUSION ODD can be detected in eyes with uveitis and may clinically mimic optic disc edema, lead to misdiagnosis and/or overtreatment.
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Affiliation(s)
- Pınar Kaya
- Department of Ophthalmology, University of Health Sciences, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | - Kübra Özdemir Yalçınsoy
- Department of Ophthalmology, University of Health Sciences, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | - Yasemin Özdamar Erol
- Department of Ophthalmology, University of Health Sciences, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
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Casado-López E, Kudsieh B, Alarcon Tomas M, Ruiz-Moreno JM. Progressive peripapillary retinal nerve fiber layer loss and visual field impairment in a child with deep and superficial optic disc drusen. J Fr Ophtalmol 2023; 46:e236-e240. [PMID: 37087324 DOI: 10.1016/j.jfo.2022.12.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 12/05/2022] [Accepted: 12/07/2022] [Indexed: 04/24/2023]
Affiliation(s)
- E Casado-López
- Department of Ophthalmology, Hospital Puerta de Hierro Majadahonda, Joaquin Rodrigo 1, 2822 Majadahonda, Madrid, Spain.
| | - B Kudsieh
- Department of Ophthalmology, Hospital Puerta de Hierro Majadahonda, Joaquin Rodrigo 1, 2822 Majadahonda, Madrid, Spain; Centro Internacional de Oftalmología Avanzada, Calle de Zurbano, 71, 28010 Madrid, Spain
| | - M Alarcon Tomas
- Department of Ophthalmology, Hospital Puerta de Hierro Majadahonda, Joaquin Rodrigo 1, 2822 Majadahonda, Madrid, Spain
| | - J M Ruiz-Moreno
- Department of Ophthalmology, Hospital Puerta de Hierro Majadahonda, Joaquin Rodrigo 1, 2822 Majadahonda, Madrid, Spain; Department of Ophthalmology, Castilla La Mancha University, Albacete, Spain
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Li Y, Dai S. Clinical approach for suspected optic disc swelling in children: recommendations based on a six-year review. Clin Exp Optom 2023; 106:793-799. [PMID: 36634626 DOI: 10.1080/08164622.2022.2156775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 11/30/2022] [Accepted: 12/05/2022] [Indexed: 01/14/2023] Open
Abstract
CLINICAL RELEVANCE Suspected optic disc swelling is a common presentation in children. The delineation between true optic disc swelling and pseudopapilloedema, its common masquerade, requires careful evaluation. A streamlined pathway is required to avoid unnecessary investigations. BACKGROUND Papilloedema requires urgent neuroimaging, however, perceived optic disc swelling is not always true papilloedema. This study aims to investigate the outcome of referrals for optic disc swelling and formulate features that may assist in investigation and diagnosis. METHODS A retrospective review of referrals for optic disc swelling to the Queensland Children's Hospital, Australia, between January 2014 and June 2020 was undertaken. RESULTS Four hundred and ten children were referred for optic disc swelling. Sixty-six patients were confirmed with optic disc swelling, and 344 patients had pseudopapilloedema. The average age was 10.10 ± 3.57 and 9.90 ± 3.50 years, respectively. The most common aetiology of optic disc swelling was idiopathic intracranial hypertension (n = 25). Optic disc drusen constituted the majority of pseudopapilloedema (n = 239) and the remainder were crowded/tilted discs (n = 105). True optic disc swelling patients were more likely to experience headache (OR = 8.68, p < 0.01) and visual disturbance (OR = 2.14, p = 0.03). B-scan was the most sensitive for the detection of optic disc drusen (100%), followed by optical coherence tomography (70.38%) and fundus autofluorescence (44.86%). The retinal nerve fibre layer thickness was significantly thicker in true optic disc swelling compared to pseudopapilloedema (p < 0.01). Twenty-two (33.33%) true optic disc swelling patients and 33 (9.59%) pseudopapilloedema patients underwent neuroimaging prior to ophthalmology review. CONCLUSIONS Suspected optic disc swelling in children is most likely pseudopapilloedema. Referrals should include neurological assessment, visual acuity, fundus photography, and optical coherence tomography to assist in the triage for ophthalmic review. Neuroimaging prior to ophthalmic review should be discouraged for children without neurological symptoms.
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Affiliation(s)
- Ye Li
- Department of Ophthalmology, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Shuan Dai
- Department of Ophthalmology, Queensland Children's Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
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Antonelli G, Ziccardi L, Barbano L, Di Renzo A, Parisi V. Morpho-Functional Assessment of Retinal Ganglion Cells and Visual Pathways in Patients with Optic Disc Drusen: Superficial Drusen Visible Height as a Marker of Impairment. J Clin Med 2023; 12:jcm12103432. [PMID: 37240544 DOI: 10.3390/jcm12103432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/04/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
The aim of this study was to assess the morpho-functional involvement of the retinal ganglion cells (RGCs) and of the visual pathways in patients with superficial (ODD-S) or deep (ODD-D) optic disc drusen. This study enrolled 17 patients with ODD (mean age of 59.10 ± 12.68 years) providing 19 eyes and 20 control subjects (mean age 58.62 ± 8.77 years) providing 20 eyes. We evaluated the following: best-corrected visual acuity, visual field mean deviation (MD), the amplitude (A) of Pattern Electroretinogram (PERG), the implicit time (IT) and A of Visual Evoked Potentials (VEPs), retinal nerve fiber layer thickness (RNFL-T) and ganglion cell thickness (GC-T). In ODD-S eyes, the drusen visible height was measured. ODD-D and ODD-S were detected in 26.3% and 73.7% of ODD eyes, respectively. Significantly (p < 0.01) reduced MD, PERG A, VEP amplitude, RNFL-T and GC-T values and significantly (p < 0.01) increased VEP IT values were found in the ODD Group as compared to the Control one. In the ODD Group, no significant correlation (p > 0.01) between PERG As and VEP ITs was found. In ODD-S, the visible height was significantly correlated (p < 0.01) with reduced MD, PERG As and RNFL-T and with increased PSD and VEP IT values. Our findings suggest that ODD might induce morpho-functional changes in RGCs and their fibers and an unrelated visual pathway dysfunction leading or not leading to visual field defects. The observed morpho-functional impairment should be ascribed to an alteration in retrograde (from the axons to the RGCs) and anterograde (from the RGCs up to the visual cortex) axoplasmic transport. In ODD-S eyes, a minimum visible height of 300 microns represented the threshold for the abnormalities, suggesting that "the higher the ODD, the worse the impairment".
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Dağdelen K, Dirican E. Optic nerve sheath diameter and axial length in patients with optic disc drusen: a cross-sectional study. Int Ophthalmol 2023; 43:2109-2117. [PMID: 36871114 DOI: 10.1007/s10792-023-02654-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 02/19/2023] [Indexed: 03/06/2023]
Abstract
AIM Measuring the optic nerve sheath diameter (ONSD) and the anteroposterior axial length of the eye in patients with optic disc drusen (ODD). METHODS A total of 43 healthy volunteers and 41 patients with ODD were included in the study. The ONSD and axial length were measured in the posterior position using an ultrasound device (E-Z Scan AB5500 +) probe with a 10 MHz frequency. The ONSD was measured 3 mm behind the globe wall. Receiver operating characteristic (ROC) curve analysis was performed to determine patients with ODD using ONSD. Any p-value of < 0.05 was accepted to demonstrate significance. RESULTS The ONSD was significantly higher (5.2 mm and 4.8 mm, p = 0.006, respectively), and the axial length was shorter (21.82 ± 2.15 mm and 23.27 ± 1.96 mm, p = 0.002, respectively) in the ODD group. The spherical equivalent was more commonly seen as hypermetropic in the ODD group (1.00 [- 0.85 to 1.75]). In the ROC analysis to determine the ONSD value in ODD diagnosis, the area under the curve was 0.6754 (95% confidence interval 0.559-0.788, p = 0.006). ONSD cutoff of 5.70 mm had a sensitivity of 0.366 and a specificity of 0.907 to diagnose ODD. CONCLUSION In this study, the ONSD was significantly higher in the ODD group. The axial length was shorter in the ODD group. This study is the first in the literature to evaluate the ONSD in patients with optic disc drusen. Further studies are needed in this regard.
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Affiliation(s)
- Kenan Dağdelen
- Department of Ophthalmology, Beytepe Şehit Murat Erdi Eker State Hospital, Ahlatlıbel Mh. 1746 Sk., 06800, Beytepe, Çankaya, Ankara, Turkey.
| | - Emrah Dirican
- Department of Ophthalmology, Konya City Hospital, Konya, Turkey
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Gise R, Heidary G. The visual morbidity of optic nerve head drusen: a longitudinal review. J AAPOS 2023; 27:30.e1-30.e5. [PMID: 36638958 DOI: 10.1016/j.jaapos.2022.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 11/13/2022] [Accepted: 11/23/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND The ophthalmologic complications of optic nerve head drusen (ONHD) in adults have been documented, whereas data on the degree of visual morbidity from OHND in children are limited. METHODS The medical records of all patients diagnosed with ONHD at a single, tertiary care ophthalmology department from January 1, 2010, until July 1, 2018, were reviewed retrospectively. Patients were identified using ICD-9 and ICD-10 codes. Inclusion criteria were age ≤18 years of age and formal documentation of ONHD by ancillary testing. RESULTS A total of 213 patients (386 eyes with ONHD) met inclusion criteria. Mean age at diagnosis was 10.13 ± 4.09 years, and mean follow-up was 2.76 ± 2.91 years. Formal visual fields were available for 208 eyes. Repeatable visual field defects were noted in 24 eyes (11.5%). The most common defect was a nasal step, which occurred in 11 eyes (45.8%). Fifteen eyes had visual field defects at presentation, and 9 eyes developed field loss within 1.39 ± 0.55 years of diagnosis. There was no correlation found between intraocular pressure and degree of visual field loss. Choroidal neovascular membranes were clinically apparent in 5 eyes and treatment was required in 3 eyes. Nonarteritic ischemic optic neuropathy developed in 2 eyes. CONCLUSIONS Visual morbidity associated with ONHD in children is common and may develop in a short period of time after initial diagnosis. There was no correlation found with intraocular pressure.
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Affiliation(s)
- Ryan Gise
- Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts, and Harvard Medical School, Boston, Massachusetts
| | - Gena Heidary
- Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts, and Harvard Medical School, Boston, Massachusetts.
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Girard MJA, Panda S, Tun TA, Wibroe EA, Najjar RP, Aung T, Thiéry AH, Hamann S, Fraser C, Milea D. Discriminating Between Papilledema and Optic Disc Drusen Using 3D Structural Analysis of the Optic Nerve Head. Neurology 2023; 100:e192-e202. [PMID: 36175153 DOI: 10.1212/wnl.0000000000201350] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 08/19/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The distinction of papilledema from other optic nerve head (ONH) lesions mimicking papilledema, such as optic disc drusen (ODD), can be difficult in clinical practice. We aimed the following: (1) to develop a deep learning algorithm to automatically identify major structures of the ONH in 3-dimensional (3D) optical coherence tomography (OCT) scans and (2) to exploit such information to robustly differentiate among ODD, papilledema, and healthy ONHs. METHODS This was a cross-sectional comparative study of patients from 3 sites (Singapore, Denmark, and Australia) with confirmed ODD, those with papilledema due to raised intracranial pressure, and healthy controls. Raster scans of the ONH were acquired using OCT imaging and then processed to improve deep-tissue visibility. First, a deep learning algorithm was developed to identify major ONH tissues and ODD regions. The performance of our algorithm was assessed using the Dice coefficient. Second, a classification algorithm (random forest) was designed to perform 3-class classifications (1: ODD, 2: papilledema, and 3: healthy ONHs) strictly from their drusen and prelamina swelling scores (calculated from the segmentations). To assess performance, we reported the area under the receiver operating characteristic curve for each class. RESULTS A total of 241 patients (256 imaged ONHs, including 105 ODD, 51 papilledema, and 100 healthy ONHs) were retrospectively included in this study. Using OCT images of the ONH, our segmentation algorithm was able to isolate neural and connective tissues and ODD regions/conglomerates whenever present. This was confirmed by an averaged Dice coefficient of 0.93 ± 0.03 on the test set, corresponding to good segmentation performance. Classification was achieved with high AUCs, that is, 0.99 ± 0.001 for the detection of ODD, 0.99 ± 0.005 for the detection of papilledema, and 0.98 ± 0.01 for the detection of healthy ONHs. DISCUSSION Our artificial intelligence approach can discriminate ODD from papilledema, strictly using a single OCT scan of the ONH. Our classification performance was very good in the studied population, with the caveat that validation in a much larger population is warranted. Our approach may have the potential to establish OCT imaging as one of the mainstays of diagnostic imaging for ONH disorders in neuro-ophthalmology, in addition to fundus photography.
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Affiliation(s)
- Michaël J A Girard
- From the Ophthalmic Engineering & Innovation Laboratory (M.J.A.G., S.P.), Singapore Eye Research Institute (T.A.T., R.P.N., T.A., D.M.), Singapore National Eye Centre; Duke-NUS Graduate Medical School (M.J.A.G., T.A.T., R.P.N., T.A., D.M.), Singapore; Institute for Molecular and Clinical Ophthalmology (M.J.A.G.), Basel, Switzerland; Department of Ophthalmology (E.A.W., S.H.), Rigshospitalet, University of Copenhagen, Denmark; Yong Loo Lin School of Medicine (R.P.N., T.A.), and Department of Statistics and Applied Probability (A.H.T.), National University of Singapore; and Save Sight Institute (C.F.), Faculty of Health and Medicine, The University of Sydney, New South Wales, Australia.
| | - Satish Panda
- From the Ophthalmic Engineering & Innovation Laboratory (M.J.A.G., S.P.), Singapore Eye Research Institute (T.A.T., R.P.N., T.A., D.M.), Singapore National Eye Centre; Duke-NUS Graduate Medical School (M.J.A.G., T.A.T., R.P.N., T.A., D.M.), Singapore; Institute for Molecular and Clinical Ophthalmology (M.J.A.G.), Basel, Switzerland; Department of Ophthalmology (E.A.W., S.H.), Rigshospitalet, University of Copenhagen, Denmark; Yong Loo Lin School of Medicine (R.P.N., T.A.), and Department of Statistics and Applied Probability (A.H.T.), National University of Singapore; and Save Sight Institute (C.F.), Faculty of Health and Medicine, The University of Sydney, New South Wales, Australia
| | - Tin Aung Tun
- From the Ophthalmic Engineering & Innovation Laboratory (M.J.A.G., S.P.), Singapore Eye Research Institute (T.A.T., R.P.N., T.A., D.M.), Singapore National Eye Centre; Duke-NUS Graduate Medical School (M.J.A.G., T.A.T., R.P.N., T.A., D.M.), Singapore; Institute for Molecular and Clinical Ophthalmology (M.J.A.G.), Basel, Switzerland; Department of Ophthalmology (E.A.W., S.H.), Rigshospitalet, University of Copenhagen, Denmark; Yong Loo Lin School of Medicine (R.P.N., T.A.), and Department of Statistics and Applied Probability (A.H.T.), National University of Singapore; and Save Sight Institute (C.F.), Faculty of Health and Medicine, The University of Sydney, New South Wales, Australia
| | - Elisabeth A Wibroe
- From the Ophthalmic Engineering & Innovation Laboratory (M.J.A.G., S.P.), Singapore Eye Research Institute (T.A.T., R.P.N., T.A., D.M.), Singapore National Eye Centre; Duke-NUS Graduate Medical School (M.J.A.G., T.A.T., R.P.N., T.A., D.M.), Singapore; Institute for Molecular and Clinical Ophthalmology (M.J.A.G.), Basel, Switzerland; Department of Ophthalmology (E.A.W., S.H.), Rigshospitalet, University of Copenhagen, Denmark; Yong Loo Lin School of Medicine (R.P.N., T.A.), and Department of Statistics and Applied Probability (A.H.T.), National University of Singapore; and Save Sight Institute (C.F.), Faculty of Health and Medicine, The University of Sydney, New South Wales, Australia
| | - Raymond P Najjar
- From the Ophthalmic Engineering & Innovation Laboratory (M.J.A.G., S.P.), Singapore Eye Research Institute (T.A.T., R.P.N., T.A., D.M.), Singapore National Eye Centre; Duke-NUS Graduate Medical School (M.J.A.G., T.A.T., R.P.N., T.A., D.M.), Singapore; Institute for Molecular and Clinical Ophthalmology (M.J.A.G.), Basel, Switzerland; Department of Ophthalmology (E.A.W., S.H.), Rigshospitalet, University of Copenhagen, Denmark; Yong Loo Lin School of Medicine (R.P.N., T.A.), and Department of Statistics and Applied Probability (A.H.T.), National University of Singapore; and Save Sight Institute (C.F.), Faculty of Health and Medicine, The University of Sydney, New South Wales, Australia
| | - Tin Aung
- From the Ophthalmic Engineering & Innovation Laboratory (M.J.A.G., S.P.), Singapore Eye Research Institute (T.A.T., R.P.N., T.A., D.M.), Singapore National Eye Centre; Duke-NUS Graduate Medical School (M.J.A.G., T.A.T., R.P.N., T.A., D.M.), Singapore; Institute for Molecular and Clinical Ophthalmology (M.J.A.G.), Basel, Switzerland; Department of Ophthalmology (E.A.W., S.H.), Rigshospitalet, University of Copenhagen, Denmark; Yong Loo Lin School of Medicine (R.P.N., T.A.), and Department of Statistics and Applied Probability (A.H.T.), National University of Singapore; and Save Sight Institute (C.F.), Faculty of Health and Medicine, The University of Sydney, New South Wales, Australia
| | - Alexandre H Thiéry
- From the Ophthalmic Engineering & Innovation Laboratory (M.J.A.G., S.P.), Singapore Eye Research Institute (T.A.T., R.P.N., T.A., D.M.), Singapore National Eye Centre; Duke-NUS Graduate Medical School (M.J.A.G., T.A.T., R.P.N., T.A., D.M.), Singapore; Institute for Molecular and Clinical Ophthalmology (M.J.A.G.), Basel, Switzerland; Department of Ophthalmology (E.A.W., S.H.), Rigshospitalet, University of Copenhagen, Denmark; Yong Loo Lin School of Medicine (R.P.N., T.A.), and Department of Statistics and Applied Probability (A.H.T.), National University of Singapore; and Save Sight Institute (C.F.), Faculty of Health and Medicine, The University of Sydney, New South Wales, Australia
| | - Steffen Hamann
- From the Ophthalmic Engineering & Innovation Laboratory (M.J.A.G., S.P.), Singapore Eye Research Institute (T.A.T., R.P.N., T.A., D.M.), Singapore National Eye Centre; Duke-NUS Graduate Medical School (M.J.A.G., T.A.T., R.P.N., T.A., D.M.), Singapore; Institute for Molecular and Clinical Ophthalmology (M.J.A.G.), Basel, Switzerland; Department of Ophthalmology (E.A.W., S.H.), Rigshospitalet, University of Copenhagen, Denmark; Yong Loo Lin School of Medicine (R.P.N., T.A.), and Department of Statistics and Applied Probability (A.H.T.), National University of Singapore; and Save Sight Institute (C.F.), Faculty of Health and Medicine, The University of Sydney, New South Wales, Australia
| | - Clare Fraser
- From the Ophthalmic Engineering & Innovation Laboratory (M.J.A.G., S.P.), Singapore Eye Research Institute (T.A.T., R.P.N., T.A., D.M.), Singapore National Eye Centre; Duke-NUS Graduate Medical School (M.J.A.G., T.A.T., R.P.N., T.A., D.M.), Singapore; Institute for Molecular and Clinical Ophthalmology (M.J.A.G.), Basel, Switzerland; Department of Ophthalmology (E.A.W., S.H.), Rigshospitalet, University of Copenhagen, Denmark; Yong Loo Lin School of Medicine (R.P.N., T.A.), and Department of Statistics and Applied Probability (A.H.T.), National University of Singapore; and Save Sight Institute (C.F.), Faculty of Health and Medicine, The University of Sydney, New South Wales, Australia
| | - Dan Milea
- From the Ophthalmic Engineering & Innovation Laboratory (M.J.A.G., S.P.), Singapore Eye Research Institute (T.A.T., R.P.N., T.A., D.M.), Singapore National Eye Centre; Duke-NUS Graduate Medical School (M.J.A.G., T.A.T., R.P.N., T.A., D.M.), Singapore; Institute for Molecular and Clinical Ophthalmology (M.J.A.G.), Basel, Switzerland; Department of Ophthalmology (E.A.W., S.H.), Rigshospitalet, University of Copenhagen, Denmark; Yong Loo Lin School of Medicine (R.P.N., T.A.), and Department of Statistics and Applied Probability (A.H.T.), National University of Singapore; and Save Sight Institute (C.F.), Faculty of Health and Medicine, The University of Sydney, New South Wales, Australia
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16
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Oral Fluorescein Angiography for the Diagnosis of Papilledema Versus Pseudopapilledema in Children. Am J Ophthalmol 2023; 245:8-13. [PMID: 36084685 DOI: 10.1016/j.ajo.2022.08.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/21/2022] [Accepted: 08/22/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE To evaluate the accuracy and safety of oral fluorescein angiography (OFA) in differentiating papilledema from pseudopapilledema in pediatric patients. DESIGN Retrospective evaluation of a diagnostic test. METHODS We retrospectively reviewed medical records of all children ≤18 years of age who presented to the Arkansas Children's Hospital between May 2018 and August 2021 with suspected optic disc (OD) swelling that had OFA and images >30 minutes after oral ingestion. Two masked specialists interpreted the images as either OD leakage, no leakage, or borderline leakage. Optic disc swelling was graded clinically according to the Frisen grading scale (0-5). We compared OFA images to the final clinical diagnosis and calculated the accuracy of the test as follows: (number of eyes correctly identified as papilledema [true positive] + number of eyes correctly identified as pseudopapilledema [true negative]) / (total number of eyes) × 100%. RESULTS Forty-five patients (90 eyes) were included, 11 patients with papilledema and 34 with pseudopapilledema. The mean age was 14.1 ± 3.5 years; 66.7% were female. The accuracy of OFA was 62% for reviewer 1 and 69% for reviewer 2. No ocular or systemic side effects after OFA were observed. There was substantial agreement (k = 0.779) between both reviewers in grading the OFA images. CONCLUSION OFA cannot definitively distinguish papilledema from pseudopapilledema in children and should be interpreted in conjunction with other clinical findings.
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Rothenbuehler SP, Malmqvist L, Belmouhand M, Bjerager J, Maloca PM, Larsen M, Hamann S. Comparison of Spectral-Domain OCT versus Swept-Source OCT for the Detection of Deep Optic Disc Drusen. Diagnostics (Basel) 2022; 12:diagnostics12102515. [PMID: 36292204 PMCID: PMC9600200 DOI: 10.3390/diagnostics12102515] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 10/10/2022] [Accepted: 10/13/2022] [Indexed: 11/17/2022] Open
Abstract
Deep optic disc drusen (ODD) are located below Bruch’s membrane opening (BMO) and may go undetected due to the challenges in imaging them. The purpose of this study is a head-to-head comparison of currently widely used imaging technologies: swept-source optical coherence tomography (SS-OCT; DRI OCT-1 Triton, Topcon) and enhanced depth imaging spectral-domain optical coherence tomography (EDI SD-OCT; Spectralis OCT, Heidelberg Engineering) for the detection of deep ODD and associated imaging features. The eyes included in this study had undergone high-resolution imaging via both EDI SD-OCT and SS-OCT volume scans, which showed at least one deep ODD or a hyperreflective line (HL). Grading was performed by three graders in a masked fashion. The study findings are based on 46 B-scan stacks of 23 eyes including a total of 7981 scans. For scan images with ODD located above or below the level of BMO, no significant difference was found between the two modalities compared in this study. However, for HLs and other features, EDI SD-OCT scan images had better visualization and less artifacts. Although SS-OCT offers deep tissue visualization, it did not appear to offer any advantage in ODD detection over a dense volume scan via EDI SD-OCT with B-scan averaging.
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Affiliation(s)
- Simon P. Rothenbuehler
- Department of Ophthalmology, Rigshospitalet, University of Copenhagen, 2600 Glostrup, Denmark
- Department of Ophthalmology, OCTlab, University Hospital Basel, 4031 Basel, Switzerland
- Correspondence: ; Tel.: +41-61-265-87-87
| | - Lasse Malmqvist
- Department of Ophthalmology, Rigshospitalet, University of Copenhagen, 2600 Glostrup, Denmark
| | - Mohamed Belmouhand
- Department of Ophthalmology, Rigshospitalet, University of Copenhagen, 2600 Glostrup, Denmark
| | - Jakob Bjerager
- Department of Ophthalmology, Rigshospitalet, University of Copenhagen, 2600 Glostrup, Denmark
| | - Peter M. Maloca
- Department of Ophthalmology, OCTlab, University Hospital Basel, 4031 Basel, Switzerland
- Institute of Molecular and Clinical Ophthalmology Basel (IOB), 4031 Basel, Switzerland
- Moorfields Eye Hospital NHS Foundation Trust, London EC1V 2PD, UK
| | - Michael Larsen
- Department of Ophthalmology, Rigshospitalet, University of Copenhagen, 2600 Glostrup, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Steffen Hamann
- Department of Ophthalmology, Rigshospitalet, University of Copenhagen, 2600 Glostrup, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
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Saint-Gerons M, Rubio M, Matheu A. Drusas de nervio óptico en el diagnóstico diferencial del edema de papila. Neurologia 2022. [DOI: 10.1016/j.nrl.2021.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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19
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Ayoub MD, Kamath BM. Alagille Syndrome: Current Understanding of Pathogenesis, and Challenges in Diagnosis and Management. Clin Liver Dis 2022; 26:355-370. [PMID: 35868679 DOI: 10.1016/j.cld.2022.03.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Alagille syndrome (ALGS) is a complex heterogenous disease with a wide array of clinical manifestations in association with cholestatic liver disease. Major clinical and genetic advancements have taken place since its first description in 1969. However, clinicians continue to face considerable challenges in the management of ALGS, particularly in the absence of targeted molecular therapies. In this article, we provide an overview of the broad ALGS phenotype, current approaches to diagnosis and with particular focus on key clinical challenges encountered in the management of these patients.
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Affiliation(s)
- Mohammed D Ayoub
- Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada; Department of Pediatrics, Rabigh Branch, King Abdulaziz University, PO Box 80205, Jeddah 21589, Saudi Arabia
| | - Binita M Kamath
- Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada.
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20
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Saint-Gerons M, Rubio MA, Matheu A. Optic nerve drusen in the differential diagnosis of optic nerve edema. NEUROLOGÍA (ENGLISH EDITION) 2022; 37:610-612. [PMID: 35523702 DOI: 10.1016/j.nrleng.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 10/11/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
- M Saint-Gerons
- Unidad de Neurooftalmología, Departamento de Oftalmología, Hospital del Mar, Barcelona, Spain.
| | - M A Rubio
- Unidad de Neurooftalmología, Departamento de Neurología, Hospital del Mar, Barcelona, Spain
| | - A Matheu
- Unidad de Neurooftalmología, Departamento de Oftalmología, Hospital del Mar, Barcelona, Spain
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21
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Ahn YJ, Park YY, Shin SY. Peripapillary hyperreflective ovoid mass-like structures (PHOMS) in children. Eye (Lond) 2022; 36:533-539. [PMID: 33731891 PMCID: PMC8873397 DOI: 10.1038/s41433-021-01461-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 01/21/2021] [Accepted: 02/09/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND To analyse structural characteristics and perifoveal/peripapillary vasculature by OCT in children with peripapillary hyperreflective ovoid mass-like structures (PHOMS) and compare the results with those of normal subjects. METHODS Forty-five patients (84 eyes) under 18 years old with blurry disc margin were evaluated with spectral domain-OCT and swept course-OCT. Patients were divided into four groups, according to presence of PHOMS and then the size of the existing PHOMS. Eyes with visible optic disc drusen (ODD) were not included. Foveal avascular zone (FAZ) and vessel densities from macula and optic disc area were assessed and potential associations between vessel density and structural parameters, such as peripapillary retinal nerve fibre layer (pRNFL), and macular ganglion cell and inner plexiform layer (mGCIPL) thickness, were analysed. RESULTS Among 45 patients (eighty-four eyes), coexisting buried ODD were found only in eyes with PHOMS. The scleral canal diameter was significantly smaller in PHOMS positive eyes compared to control eyes. Vessel density measurements from the papillary, peripapillary and optic nerve head (ONH) regions in the large PHOMS group were significantly lower compared to the control group (papillary; P = 0.014, peripapillary; P = 0.001, ONH; P = 0.046). FAZ area and macular vessel densities showed no difference compared to normal eyes in all three PHOMS groups. pRNFL and mGCIPL thickness did not differ among four groups and correlations were also not significant. CONCLUSIONS Children with PHOMS have smaller scleral canal and can entail buried ODD. Vessel densities of optic disc area in large PHOMS eyes are significantly lower than in normal eyes.
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Affiliation(s)
- Ye Jin Ahn
- grid.411947.e0000 0004 0470 4224Department of Ophthalmology and Visual Science, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yoo Yeon Park
- grid.411947.e0000 0004 0470 4224Department of Ophthalmology and Visual Science, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sun Young Shin
- Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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22
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Pediatric Headache in Primary Care and Emergency Departments: Consensus with RAND/UCLA Method. Life (Basel) 2022; 12:life12020142. [PMID: 35207430 PMCID: PMC8877535 DOI: 10.3390/life12020142] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/06/2022] [Accepted: 01/12/2022] [Indexed: 01/09/2023] Open
Abstract
Headache is the most frequent neurological symptom in childhood and the main reason for admission to pediatric emergency departments. The aim of this consensus document is to define a shared clinical pathway between primary care pediatricians (PCP) and hospitals for the management of children presenting with headache. For the purposes of the study, a group of hospital pediatricians and a group of PCP from the Emilia Romagna’s health districts were selected to achieve consensus using the RAND/UCLA appropriateness method. Thirty-nine clinical scenarios were developed: for each scenario, participants were asked to rank the appropriateness of each option from 1 to 9. Agreement was reached if ≥75% of participants ranked within the same range of appropriateness. The answers, results, and discussion helped to define the appropriateness of procedures with a low level of evidence regarding different steps of the diagnostic-therapeutic process: primary care evaluation, emergency department evaluation, hospital admission, acute therapy, prophylaxis, and follow-up. The RAND proved to be a valid method to value appropriateness of procedures and define a diagnostic-therapeutic pathway suitable to the local reality in the management of pediatric headache. From our results, some useful recommendations were developed for optimizing the healthcare professionals’ network among primary care services and hospitals.
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Genizi J, Meiselles D, Arnowitz E, Segal I, Cohen R, Goldenberg-Cohen N. Optic Nerve Drusen Is Highly Prevalent Among Children With Pseudotumor Cerebri Syndrome. Front Neurol 2021; 12:789673. [PMID: 34966353 PMCID: PMC8710470 DOI: 10.3389/fneur.2021.789673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 11/12/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: The clinical presentation of pseudotumor cerebri syndrome (PTCS) usually includes headache, nausea, and vomiting with normal physical examination apart from papilledema and diplopia. However, pseudopapilledema, which can be caused by optic nerve drusen, may lead to misdiagnosis. The prevalence of optic nerve drusen in the general population is 0.5–2%. The purpose of our study was to evaluate the prevalence and risk factors of optic nerve drusen among patients with PTCS. Materials and Methods: Medical records of children evaluated in the pediatric department at Bnai Zion Medical Center due to PTCS between 2008 and 2020 were assessed. Inclusion criteria were children age under 18 years with a PTCS diagnosis and ophthalmic B-mode ultrasonography (US). Exclusion criteria were secondary intracranial hypertension. Results: Thirty-four children were included with a mean age 10.1 years which included 50% boys. A majority of the patients, 24 (72.4%), complained of headaches, while 15 (45.5%) complained of transient visual obscuration, and 9 (26.5%) of vomiting. Visual acuity on presentation was normal (20/20–20/30) in 23 of the children (67%), moderately diminished (20/40–20/80) in 9 (26%), and showing profound loss (20/200) in 2 (7%). Five patients (14.7%) were diagnosed with optic nerve drusen via B-mode ophthalmic ultrasonography (US). However, they still fulfilled the diagnostic criteria for PTCS, and disc swelling improved after treatment. There were no statistically significant differences between the group with optic nerve drusen and the rest of the patients. Conclusions: Optic nerve drusen are common among pediatric patients with PTCS. Diagnosis of optic nerve drusen should not rule out the presence of increased intracranial pressure.
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Affiliation(s)
- Jacob Genizi
- Pediatric Neurology Unit, Bnai Zion Medical Center, Haifa, Israel.,Pediatric Department, Bnai Zion Medical Center, Haifa, Israel.,Bruce Rappaport Faulty of Medicine, Technion, Haifa, Israel
| | - Doron Meiselles
- Pediatric Department, Bnai Zion Medical Center, Haifa, Israel
| | | | - Idan Segal
- Pediatric Neurology Unit, Bnai Zion Medical Center, Haifa, Israel
| | - Rony Cohen
- Department of Pediatric Neurology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Nitza Goldenberg-Cohen
- Bruce Rappaport Faulty of Medicine, Technion, Haifa, Israel.,Ophthalmology Department, Bnai Zion Medical Center, Haifa, Israel
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Enhanced Depth Imaging Optical Coherence Tomography Technology Reveals a Significant Association Between Optic Nerve Drusen Anterior Displacement and Retinal Nerve Fiber Layer Thinning Over Time. J Neuroophthalmol 2021; 41:e483-e489. [PMID: 33110003 DOI: 10.1097/wno.0000000000001103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Optic disc drusen (ODD) are a dynamic phenomenon, and their appearance, size, and relative location may change. The purpose of this study is to evaluate and quantify the longitudinal changes of buried ODD with enhanced depth imaging (EDI) optical coherence tomography (OCT) over time. METHODS ODD were analyzed with Spectralis OCT (Heidelberg Engineering, Heidelberg, Germany) and EDI technology. The peripapillary retinal nerve fiber layer (RNFL) thickness was also measured. The size and depth of ODD were compared between the baseline and study visit (at least 2 years of follow-up), and the changes were correlated with mean RNFL thickness. The repeatability, coefficient of variation, and cutoff values for size and depth on EDI-OCT were calculated. RESULTS Of 21 previously identified patients with ODD, only 12 patients (21 eyes) met the most recent diagnostic criteria according to the ODD Studies Consortium recommendations for using OCT-EDI technology. The 21 eyes were reanalyzed after a mean period of 44.7 ± 13.2 months (range: 24-71 months). Overall, 132 ODD were evaluated with a mean of 6.1 ± 2.5 ODD per eye and 1.9 ± 1.1 ODD per scan. Overall, we found a significant forward movement of the drusen between visits (P = 0.01). Most drusen (67.4%) moved anteriorly, and in approximately one-third (35.6%), this displacement exceeded the cutoff value (64.28 µm). Furthermore, we found a significant correlation between ODD shallowing and RNFL thinning during the follow-up (P ≤ 0.03; R ≥ 0.370). We did not find any significant changes in size measurements (P = 0.10) over time. CONCLUSIONS In approximately one-third of buried ODD, a significant anterior movement occurred over 2 years of follow-up, and this movement was associated with significant RNFL thinning. By contrast, no significant change was detected in the size of the buried ODD.
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Sager G, Kaplan AT, Yalçin SÖ, Çalişkan E, Akın Y. Evaluation of the signs and symptoms of pseudotumor cerebri syndrome in pediatric population. Childs Nerv Syst 2021; 37:3067-3072. [PMID: 34263340 DOI: 10.1007/s00381-021-05279-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 06/29/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE Pseudotumor cerebri syndrome (PTC) is characterized by increased intracranial pressure without a space-occupying lesion and a normal cerebrospinal fluid (CSF) composition without evidence of CSF infection. In this study, we aimed to compare the symptoms, signs, and clinical characteristics of patients presenting with a preliminary diagnosis of pseudotumor cerebri syndrome (PTC) who were diagnosed and not diagnosed with PTC. METHOD We conducted a retrospective study of patients who were referred to our clinic with signs and symptoms of PTC. We compared the patients' symptoms, signs, and clinical characteristics who were diagnosed with PTC with those who were not diagnosed with PTC using modified Dandy criteria. RESULTS Ninety-four patients with the pre-diagnosis of PTC were included in the study. LP procedure was done in all patients. After LP, 75.3% of the patients were diagnosed with PTC, but 24.7% did not meet the criteria for PTC. A statistically significant relationship was found between the increase in headache complaints when leaning forward, headache that keeps the child from playing, and the CSF pressure level (p = 0.014, p = 0.019; p < 0.05). There was no statistically significant correlation between papilledema and CSF pressure level (p > 0.05). A statistically significant relationship was found between papilledema grade and CSF pressure level (p = 0.038; p < 0.05), and the rate of high CSF pressure in the groups with Grades 2-3 and Grade 4 papilledema was higher than that in the group with Grade 1 papilledema. Cranial nerve 6 palsy (CN6) (p = 0.048) and flattening of the posterior aspect of the globe (FPS) are found independent risk factors (p = 0.004 p < 0.05). CONCLUSIONS PTC signs and symptoms show variability among pediatric population.
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Affiliation(s)
- G Sager
- Department of Pediatric Neurology, Kartal Dr. Lutfi Kirdar City Hospital, Semsi Denizer Avenue, Cevizli, 34890, Kartal, Istanbul, Turkey.
| | - A T Kaplan
- Department of Ophthalmology, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
| | - S Ö Yalçin
- Department of Ophthalmology, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
| | - E Çalişkan
- Department of Radiology, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
| | - Y Akın
- Department of Pediatrics, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
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Klefter ON, Wegener M, Hamann S. Optic disc drusen diagnosed by optical coherence tomography in a 3-year-old child. Acta Ophthalmol 2021; 99:e972. [PMID: 33326175 DOI: 10.1111/aos.14695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 11/03/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Oliver Niels Klefter
- Department of Ophthalmology, Rigshospitalet University of Copenhagen Glostrup Denmark
| | - Marianne Wegener
- Department of Ophthalmology, Rigshospitalet University of Copenhagen Glostrup Denmark
| | - Steffen Hamann
- Department of Ophthalmology, Rigshospitalet University of Copenhagen Glostrup Denmark
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Thompson DA, Marmoy OR, Prise KL, Reynolds VM, Handley SE, Versace DM, Kafiabadi S, Mankad K, Panteli V, Schwiebert K, James G, Bowman R. Giant pattern VEPs in children. Eur J Paediatr Neurol 2021; 34:33-42. [PMID: 34388649 DOI: 10.1016/j.ejpn.2021.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 05/22/2021] [Accepted: 07/22/2021] [Indexed: 10/20/2022]
Abstract
Our aim is to elaborate the clinical significance of giant amplitude pattern reversal visual evoked potentials (VEPs) in children. 'Giant' amplitude VEPs exceed the upper 97.5th centile, 90% CI for age. We scrutinised 2750 pattern VEPs recorded to international standards between Jan 2015 and 2017 from children aged 16 years and under, attending a specialist children's hospital. Twenty seven children, median age 6yrs, (range 1-16 yrs), were identified with giant VEPs (P100 amplitude range 65-163 μV). Most, 22/27 (81%), had conditions associated with a risk of raised ICP. Sixteen of these twenty two children had craniosynostosis; six multi-sutural and eight single suture disease. Others had Idiopathic Intracranial Hypertension, arachnoid cyst, NF1 with shunted hydrocephalus, chronic infantile neurological cutaneous and articular (CINCA) syndrome, nephrotic cystinosis and obstructive sleep apnoea. Five children presented with a range of conditions, some associated with seizures some symptomatic, but as yet undiagnosed. Frequent structural associations were optical coherence tomography measures of optic disc maximum anterior axial horizontal retinal thickness projection >160 μm and neuro-radiological findings of CSF effacement and copper beaten appearance. Ultrasonography measures of optic nerve sheath diameters varied, but in one child took 2 years to resolve after treatment for raised ICP. Optic disc gradings by fundoscopy were mostly normal, as were visual acuities. Raised ICP was confirmed by gold standard ICP bolt measurements in five of seven children tested. These data suggest that rICP should be considered if a child has sustained giant amplitude VEPs at normal latency.
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Affiliation(s)
- Dorothy A Thompson
- Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London, WC1N 3JH, UK; Ulverscroft Vision Research Group, UCL Great Ormond Street Institute for Child Health, 30 Guilford Street, London, WC1N 1EH, UK.
| | - Oliver R Marmoy
- Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London, WC1N 3JH, UK; Ulverscroft Vision Research Group, UCL Great Ormond Street Institute for Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Katrina L Prise
- Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London, WC1N 3JH, UK
| | - Victoria M Reynolds
- Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London, WC1N 3JH, UK
| | - Sian E Handley
- Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London, WC1N 3JH, UK; Ulverscroft Vision Research Group, UCL Great Ormond Street Institute for Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Dominique M Versace
- Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London, WC1N 3JH, UK
| | - Sina Kafiabadi
- Neuroradiology Department, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London, WC1N 3JH, UK
| | - Kshitij Mankad
- Neuroradiology Department, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London, WC1N 3JH, UK
| | - Vasiliki Panteli
- Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London, WC1N 3JH, UK
| | - Kemmy Schwiebert
- Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London, WC1N 3JH, UK
| | - Greg James
- Department of Neurosurgery, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London, WC1N 3JH, UK; Craniofacial Research Group, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Richard Bowman
- Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London, WC1N 3JH, UK; Ulverscroft Vision Research Group, UCL Great Ormond Street Institute for Child Health, 30 Guilford Street, London, WC1N 1EH, UK
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Abstract
Purpose of review Optic nerve head elevation can be associated with vision loss. This review provides an update regarding key features of optic disc drusen (ODD) compared with papilledema from increased intracranial pressure and optic disc edema from other causes. Recent findings Clinical history and funduscopic examination are not sufficient to correctly diagnose different causes of optic nerve head elevation. Multimodal ophthalmic imaging is noninvasive and should be used as first-line diagnostic testing to distinguish optic disc edema or papilledema from pseudoedema. Advanced ophthalmic imaging, including enhanced depth imaging optical coherence tomography (EDI-OCT) and autofluorescence imaging, can visualize ODD at high resolution and determine whether there is optic disc edema. OCT angiography does not require contrast and can rapidly visualize papillary, peripapillary, and macular microvasculature and identify important vascular biomarker of ischemia and, potentially, visual prognosis. Summary Multimodal ophthalmic imaging can help in the diagnosis of ODD and optic disc edema and identify patients at high risk of vision loss and neurological issues in order to ensure appropriate diagnosis and treatment.
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Danišová J, Fric E. DIAGNOSTICS OF OPTIC DISC DRUSEN IN CHILDREN WITH SWEPT SOURCE OCT IMAGING. CESKA A SLOVENSKA OFTALMOLOGIE : CASOPIS CESKE OFTALMOLOGICKE SPOLECNOSTI A SLOVENSKE OFTALMOLOGICKE SPOLECNOSTI 2021; 77:80-86. [PMID: 33985337 DOI: 10.31348/2021/11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIM The aim of this retrospective study is to compare two methods of optic disc drusen imaging in pediatric patients - new swept source OCT technology with the B-scan ultrasonography, which has been assumed to be a gold standard in diagnosing optic disc drusen, and to compare pRNFL thickness in children with optic disc drusen and control group. METHODS 14 eyes of 8 pediatric patients in whom optic disc drusen were confirmed by either B-scan ultrasonography, or swept-source OCT, were included in the study. We compared the sensitivity of these two imaging methods. Then we compared an average pRNFL thickness and pRNFL thickness in all four quadrants of our study group with the control group. Two statistical methods were used in data analysis - Mann-Whitney a Kruskal-Wallis test. RESULTS The difference between SS-OCT and B-scan ultrasonography was not statistically significant in diagnosing optic disc drusen. Average pRNFL thickness was 135.29 ± SD 31.2 μm in eyes with optic disc drusen, which is 24.15 % higher than in control group (p = 0.00214; p = 0.00207). pRNFL thickness of temporal (p = 0.0001; p = 0.0001), superior (p = 0.03486; p = 0.03361) and inferior (p = 0.00652; p = 0.00627) quadrant was statistically significantly higher in comparison with healthy controls, whereas the difference of pRNFL thickness in nasal quadrant was not statistically significant between the study and control group (p = 0.09692; p = 0.0947). CONCLUSION Swept source OCT is a promising new "gold standard" in optic disc drusen diagnostics in pediatric patients. An increase in pRNFL thickness values does not always confirm papilloedema as optic disc drusen may be the cause. Direct visualisation of optic disc drusen by swept source OCT can aid in differentiation from true papilloedema.
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Yan Y, Ludwig CA, Liao YJ. Multimodal Imaging Features of Optic Disc Drusen. Am J Ophthalmol 2021; 225:18-26. [PMID: 33485838 PMCID: PMC10710938 DOI: 10.1016/j.ajo.2020.12.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 12/01/2020] [Accepted: 12/21/2020] [Indexed: 01/06/2023]
Abstract
PURPOSE To identify key en face multimodal imaging features of optic disc drusen (ODD). DESIGN Retrospective cross-sectional study. METHODS Setting: a single academic center. Patient orStudyPopulation: 786 patients (10-82 years of age) with diagnostic codes for optic disc drusen (ODD) in clinical notes extracted using natural language processing. Intervention orObservationProcedures: color fundus imaging, green-light and blue-light fundus autofluorescence (FAF), near-infrared reflectance (NIR), and enhanced-depth imaging optical coherence tomography (EDI-OCT). MainOutcomeMeasurements: Ophthalmic imaging characteristics and sensitivity of en face imaging compared with EDI-OCT. RESULTS A total of 38 patients (61 eyes) had high-quality EDI-OCT scans and en face multimodal imaging. Green-light FAF imaging had the highest diagnostic sensitivity (96.8%) for ODD and showed homogeneous hyperautofluorescence, whereas blue-light FAF imaging had heterogeneous brightness, which helped differentiate superficial from deep ODD. Blue-light FAF (93.5%) and NIR (91.8%) imaging were also sensitive tests and revealed papillary and peripapillary features that were not well seen on green-light FAF, including the size and depth of ODD, morphology of the optic disc, and common ODD-associated structures such as horizontal hyper-reflective lines and peripapillary hyper-reflective ovoid mass-like structures (PHOMS). Color fundus imaging had the lowest sensitivity (82%). There was good inter-rater reliability for all en face imaging modalities (P < .0001 for all). CONCLUSIONS In en face imaging, green-light FAF had the highest sensitivity for the diagnosis of ODD, whereas blue-light FAF and NIR images provided more information regarding the severity, location, depth, and size of ODD. In eyes that are negative on green-light FAF, EDI-OCT should be performed and provides the highest-resolution characterization of the entire optic disc to assess or rule out ODD.
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Affiliation(s)
- Yan Yan
- Department of Ophthalmology, Stanford University School of Medicine, Stanford, California, USA; Department of Ophthalmology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Cassie A Ludwig
- Department of Ophthalmology, Stanford University School of Medicine, Stanford, California, USA; Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Yaping Joyce Liao
- Department of Ophthalmology, Stanford University School of Medicine, Stanford, California, USA; Department of Neurology, Stanford University School of Medicine, Stanford, California, USA.
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Gambrelle J, Bobo C, Robinet A, Grange JD. [Peripapillary choroidal neovascularization related to optic disc drusen treated by ranibizumab: Results at 6 years]. J Fr Ophtalmol 2021; 44:e381-e383. [PMID: 33875236 DOI: 10.1016/j.jfo.2020.11.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 11/18/2020] [Accepted: 11/19/2020] [Indexed: 11/17/2022]
Affiliation(s)
- J Gambrelle
- Service d'ophtalmologie, clinique Pasteur, 32, rue Auguste-Kervern, 29200 Brest, France.
| | - C Bobo
- Service d'ophtalmologie, clinique Pasteur, 32, rue Auguste-Kervern, 29200 Brest, France
| | - A Robinet
- Service d'ophtalmologie, clinique Pasteur, 32, rue Auguste-Kervern, 29200 Brest, France
| | - J-D Grange
- Service d'ophtalmologie, hôpital de la Croix-Rousse, 103, grande rue de la Croix-Rousse, 69317 Lyon cedex 04, France
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Al-Bakri M, Larsen AC, Malmqvist L, Hamann S. Ipsilateral Recurrence of Optic Disc Drusen-Associated Anterior Ischemic Optic Neuropathy in a 15-Year-Old Boy. J Neuroophthalmol 2021; 41:e36-e38. [PMID: 32235222 DOI: 10.1097/wno.0000000000000941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Moug Al-Bakri
- Department of Ophthalmology, Rigshospitalet, University of Copenhagen, Glostrup, Denmark
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Türay S, Kabakuş N, Hancı F, Ulaş F, Dilek M, Cihan B. The role of clinical signs in the diagnosis of papilledema: development of an algorithm. Childs Nerv Syst 2021; 37:599-605. [PMID: 32839852 DOI: 10.1007/s00381-020-04869-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 08/20/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this study was not only to emphasize the role of clinical signs as well as ophthalmologic evaluation for accurate and differential diagnosis of papilledema (PE), but also to present an instructive algorithm that would help to eliminate unnecessary examinations and treatments. METHOD The files of 43 patients (ages 0-18) diagnosed with PE were retrospectively reviewed. The study included 25 patients from our pediatric neurology outpatient clinic, who were thought to have PE, and 18 patients, who were referred from the external centers to our hospital with a pre-diagnosis of PE. RESULTS Of the 43 patients, 28 had PE, 8 had pseudopapilledema (PPE), and 7 had optic nerve pathologies (ONP). For patients who applied directly to our pediatric neurology unit, a margin of error of 8% was detected based on only a simple ophthalmologic examination and an evaluation of clinical findings. For the patients who were forwarded to our pediatric neurology unit from the external centers without examining any clinical findings and with no details, the margin of error was 72%. CONCLUSION For patients with suspected PE, advanced ophthalmologic opinion is a necessary requirement before invasive radiological examinations are used. When the ophthalmologic evaluation is properly elaborated, the distinction can be made more clearly by using noninvasive methods. In order to determine the gold standard in terms of the methods used in the evaluation of patients who are not clinically diagnosed, new prospective studies with more patients should be planned.
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Affiliation(s)
- Sevim Türay
- Department of Pediatric Neurology, Faculty of Medicine, Abant Izzet Baysal University, Bolu, Turkey.
| | - Nimet Kabakuş
- Department of Pediatric Neurology, Faculty of Medicine, Abant Izzet Baysal University, Bolu, Turkey
| | - Fatma Hancı
- Department of Pediatric Neurology, Faculty of Medicine, Abant Izzet Baysal University, Bolu, Turkey
| | - Fatih Ulaş
- Department of Ophthalmology, Faculty of Medicine, Abant Izzet Baysal University, Bolu, Turkey
| | - Mustafa Dilek
- Department of Pediatrics, Faculty of Medicine, Abant Izzet Baysal University, Bolu, Turkey
| | - Büşra Cihan
- Department of Pediatrics, Faculty of Medicine, Abant Izzet Baysal University, Bolu, Turkey
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Türker IÇ, Doğan CU, Uzun SÜ, Güven D. Peripapillary vessel density in pediatric cases with buried optic disk drusen. Int Ophthalmol 2021; 41:1337-1345. [PMID: 33459960 DOI: 10.1007/s10792-021-01700-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 01/08/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND To evaluate the retinal nerve fiber layer (RNFL) and peripapillary vascular density (VD) changes in the pediatric group with optic disk drusen (ODD). METHODS Sixty eyes of 30 patients with buried ODD referred by the pediatric or neurology physicians to ophthalmology clinic with a preliminary diagnosis of papillary edema were included in this retrospective study. Sixty eyes of 30 healthy children were included as the control group. Thickness of RNFL (micrometer) and VD percentages (%) of the superior, inferior, nasal, and temporal quadrants of the peripapillary region of all cases were evaluated with optical coherence tomography angiography (OCT-A) device. RESULTS The study and control groups were homogeneous in terms of age and gender. VD values were significantly lower in the study group for all four quadrants, when compared to controls (p < 0.001, p < 0.001, p = 0.003, and p < 0.001, for inferior, superior, nasal, and temporal quadrants, respectively. For RFNL thickness measurements, a significant difference between groups was only evident for the nasal quadrant, where the study group had significantly higher nasal RFNL thickness (p = 0.001). CONCLUSION This study detected decreases in peripapillary VD values in all quadrants and peripapillary RNFL thickening in nasal quadrant in pediatric cases with buried drusen compared to healthy controls. Further studies are necessary to reveal the effects of drusen pathogenesis on optic nerve head perfusion and to understand the underlying mechanisms of related complications.
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Affiliation(s)
- Ibrahim Çağrı Türker
- Department of Ophthalmology, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Halaskargazi Avenue, Etfal Street 34371, Şişli, Istanbul, Turkey.
| | - Ceylan Uslu Doğan
- Department of Ophthalmology, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Halaskargazi Avenue, Etfal Street 34371, Şişli, Istanbul, Turkey
| | - Saniye Üke Uzun
- Department of Ophthalmology, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Halaskargazi Avenue, Etfal Street 34371, Şişli, Istanbul, Turkey
| | - Dilek Güven
- Department of Ophthalmology, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Halaskargazi Avenue, Etfal Street 34371, Şişli, Istanbul, Turkey
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Chiu HH, Yang FP, VandenHoven C, Wan MJ. Utility of spectral domain OCT in differentiating optic disc drusen from papilledema in children. Can J Ophthalmol 2021; 56:250-255. [PMID: 33454237 DOI: 10.1016/j.jcjo.2020.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/24/2020] [Accepted: 12/07/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The purpose of this study was to test the diagnostic accuracy of optical coherence tomography (OCT) in differentiating optic disc drusen (ODD) from papilledema in children. DESIGN Retrospective cross-sectional study at a tertiary-care pediatric hospital. PARTICIPANTS Children with high-quality OCT imaging of ODD or papilledema. METHODS Quantitative OCT parameters and qualitative OCT features were compared for diagnostic accuracy. RESULTS There were 41 eyes with ODD and 21 eyes with papilledema. Both the quantitative and qualitative OCT parameters showed highly statistically significant differences between ODD and papilledema (p ≤ 0.01 for all). For quantitative parameters (Bruch's membrane opening and retinal nerve fiber layer thicknesses), the area under the curve from the receiver operator curves ranged from 0.81 to 0.90. For qualitative parameters, the sensitivity for ODD ranged from 27% to 100% and specificity ranged from 67% to 100%. The presence of at least 1 of 3 qualitative OCT parameters (hyporeflective boot-shaped area, isolated/clustered hyperreflective bands, or signal-poor regions in the core) had a sensitivity of 90% and a specificity of 100% for ODD. CONCLUSIONS Both quantitative and qualitative OCT parameters differed significantly between ODD and papilledema in this cohort of children. A combination of several qualitative OCT features had high sensitivity for ODD while effectively ruling out papilledema.
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Affiliation(s)
- Hannah H Chiu
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Francine P Yang
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada; Department of Ophthalmology and Vision Sciences, Sick Kids Hospital, Toronto, Ontario, Canada
| | - Cynthia VandenHoven
- Department of Ophthalmology and Vision Sciences, Sick Kids Hospital, Toronto, Ontario, Canada
| | - Michael J Wan
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada; Department of Ophthalmology and Vision Sciences, Sick Kids Hospital, Toronto, Ontario, Canada.
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Ayoub MD, Kamath BM. Alagille Syndrome: Diagnostic Challenges and Advances in Management. Diagnostics (Basel) 2020; 10:E907. [PMID: 33172025 PMCID: PMC7694636 DOI: 10.3390/diagnostics10110907] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/02/2020] [Accepted: 11/04/2020] [Indexed: 12/21/2022] Open
Abstract
Alagille syndrome (ALGS) is a multisystem disease characterized by cholestasis and bile duct paucity on liver biopsy in addition to variable involvement of the heart, eyes, skeleton, face, kidneys, and vasculature. The identification of JAG1 and NOTCH2 as disease-causing genes has deepened our understanding of the molecular mechanisms underlying ALGS. However, the variable expressivity of the clinical phenotype and the lack of genotype-phenotype relationships creates significant diagnostic and therapeutic challenges. In this review, we provide a comprehensive overview of the clinical characteristics and management of ALGS, and the molecular basis of ALGS pathobiology. We further describe unique diagnostic considerations that pose challenges to clinicians and outline therapeutic concepts and treatment targets that may be available in the near future.
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Affiliation(s)
- Mohammed D. Ayoub
- Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON M5G 1X8, Canada;
- Department of Pediatrics, Faculty of Medicine, Rabigh Branch, King Abdulaziz University, P.O. Box 80205, Jeddah 21589, Saudi Arabia
| | - Binita M. Kamath
- Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON M5G 1X8, Canada;
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Costello F, Rothenbuehler SP, Sibony PA, Hamann S. Diagnosing Optic Disc Drusen in the Modern Imaging Era: A Practical Approach. Neuroophthalmology 2020; 45:1-16. [PMID: 33762782 DOI: 10.1080/01658107.2020.1810286] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Optic disc drusen (ODD) are a well-recognised cause of an elevated optic disc appearance. When visible with ophthalmoscopy and fundus photography, ODD are readily identified. Yet, in more subtle cases of ODD, ancillary testing may be needed to render the diagnosis. Facilitating the diagnosis of ODD has clinical relevance, because affected individuals may otherwise undergo unnecessary costly and invasive investigations to rule out raised intracranial pressure and other causes of optic disc oedema. In this review, the role of established and emerging optical coherence tomography (OCT) techniques in the diagnosis and management of ODD cases is reviewed. A practical approach is taken to explain how to optimise use of commercially available OCT technology in the clinical setting. Optical coherence tomography provides many advantages over other imaging modalities in the diagnosis of ODD, including the ability to correlate retinal measures of neuroaxonal structure with drusen characteristics. Earlier spectral domain OCT techniques, however, were hindered by poor penetrance. In the modern imaging era, enhanced depth imaging OCT and swept source OCT enable higher resolution of ODD and other optic nerve head structures that might otherwise be mistaken for drusen. Ongoing studies featuring OCT angiography indicate that this technique may provide complementary information about microvascular supply that correlate with structural measures of optic nerve injury. Advances in OCT will continue to improve diagnostic accuracy and inform clinical understanding regarding structure-function correlations germane to the longitudinal follow up of ODD patients.
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Affiliation(s)
- F Costello
- Departments of Clinical Neurosciences and Surgery, University of Calgary, Calgary, Alberta, Canada
| | - S P Rothenbuehler
- Department of Ophthalmology, University Hospital Basel, Switzerland.,Department of Ophthalmology, Rigshospitalet, University of Copenhagen, Glostrup, Denmark
| | - P A Sibony
- Department of Ophthalmology, State University of New York at Stony Brook, Stony Brook, New York, USA
| | - S Hamann
- Department of Ophthalmology, Rigshospitalet, University of Copenhagen, Glostrup, Denmark
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Clinical Features of Optic Disc Drusen in an Ophthalmic Genetics Cohort. J Ophthalmol 2020; 2020:5082706. [PMID: 33083048 PMCID: PMC7557906 DOI: 10.1155/2020/5082706] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/19/2020] [Accepted: 09/19/2020] [Indexed: 11/26/2022] Open
Abstract
Materials and Methods Electronic medical records of patients evaluated in the Ophthalmic Genetics clinic at the National Eye Institute (NEI) between 2008 and 2018 were searched for a superficial ODD diagnosis. Color fundus and autofluorescence images were reviewed to confirm ODD, supplemented with optical coherence tomography (OCT) in uncertain cases when available. Demographic information, examination, and genetic testing were reviewed. Disc areas and disc-to-macula distance to disc diameter ratios (DM : DD) were calculated. Results Fifty six of 6207 patients had photographically confirmed ODD (0.9%). Drusen were predominantly bilateral (66%), with a female (62%) and Caucasian (73%) predilection. ODD prevalence in our cohort of patients with inherited retinal degenerations was 2.5%, and ODD were more prevalent in the rod-cone dystrophy subgroup at 2.95% (OR = 3.3 [2.1–5.3], P < 0.001) compared to the ophthalmic genetics cohort. Usher patients were more likely to have ODD (10/132, 7.6%, OR = 9.0 [4.3–17.7], P < 0.001) and had significantly smaller discs compared to the rest of our ODD cohort (disc area: P=0.001, DM : DD: P=0.03). Discussion. While an association between ODD and retinitis pigmentosa has been reported, this study surveys a large cohort of patients with inherited eye conditions and finds the prevalence of superficial ODD is lower than that in the literature. Some subpopulations, such as rod-cone dystrophy and Usher syndrome, had a higher prevalence than the cohort as a whole.
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Alarcón-Tomas M, Kudsieh B, Lopez-Franca EC, Cohen Y, Ruiz-Moreno JM. Microvascular alterations in children with optic disk drusen evaluated by optical coherence tomography angiography. Graefes Arch Clin Exp Ophthalmol 2020; 259:769-776. [PMID: 33057903 DOI: 10.1007/s00417-020-04970-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 09/23/2020] [Accepted: 10/05/2020] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To asses changes in vessel density (VD) in children with optic disk drusen (ODD) using swept source optical coherence tomography angiography (OCTA). METHODS Cross-sectional study of 27 eyes with ODD compared with age-matched controls. Peripapillary and macular VD were measured in the superficial retinal capillary plexus (SCP), deep capillary plexus (DCP), and choriocapillaris (CC). The correlation between VD changes with alterations in retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), and visual field (VF) was analyzed. RESULTS Mean participant age was 12.5 ± 3.3 years (range, 7-18 years); 63% was females. In the patients vs. controls, median central peripapillary VD was 52.9% vs. 50.6% (p = 0.63) for SCP; 48.1% vs. 53.8% (p = 0.017) for DCP; and 17.0% vs. 28.2% (p = 0.0037) for CC, respectively. VD in the superior and nasal CC layers was significantly lower in the patients (36.3% vs. 56.2%; p < 0.001) and (60.4% vs. 70.3%, p < 0.001), respectively. No significant differences were observed for VD in the macular region. The RNFL was thinner in eyes with superficial drusen versus controls (87 vs. 111 μm; p < 0.001). No significant differences between were observed in GCL thickness (p = 0.13). Nasal SCP and nasal RNFL VD were moderately correlated (r = 0.54, p < 0.01), while mean VF deviation was strongly correlated with median SCP VD in patients with superficial drusen (r = 0.9, p = 0.03). CONCLUSION Impaired VD was observed in the peripapillary nasal CC in patients with ODD; this impairment was associated with a decreased RNFL thickness. Nasal SCP VD and RNFL thickness were moderately correlated in patients with ODD.
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Affiliation(s)
- María Alarcón-Tomas
- Department of Ophthalmology, University Hospital Puerta de Hierro Majadahonda, Joaquin Rodrigo 1, 28222, Madrid, Spain.
| | - Bachar Kudsieh
- Department of Ophthalmology, University Hospital Puerta de Hierro Majadahonda, Joaquin Rodrigo 1, 28222, Madrid, Spain.,Centro Internacional de Oftalmología Avanzada, Madrid, Spain
| | - Esther Casado Lopez-Franca
- Department of Ophthalmology, University Hospital Puerta de Hierro Majadahonda, Joaquin Rodrigo 1, 28222, Madrid, Spain
| | - Yael Cohen
- Department of Ophthalmology, University Hospital Puerta de Hierro Majadahonda, Joaquin Rodrigo 1, 28222, Madrid, Spain
| | - José M Ruiz-Moreno
- Department of Ophthalmology, University Hospital Puerta de Hierro Majadahonda, Joaquin Rodrigo 1, 28222, Madrid, Spain.,Castilla La Mancha University, Albacete, Spain
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40
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Oliveira-Ferreira C, Leuzinger-Dias M, Tavares-Ferreira J, Faria O, Falcão-Reis F. The Relationship between Intraocular Pressure and Optic Nerve Structural and Functional Damage in Patients with Optic Nerve Head Drusen. Neuroophthalmology 2020; 44:290-293. [PMID: 33012917 DOI: 10.1080/01658107.2019.1691242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
The aim of this retrospective study was to evaluate if, in ocular normotensive patients, at the time of diagnosis of optic nerve head drusen (ONHD), perimetric mean deviation (PMD) on visual field (VF) examination and retinal nerve fibre layer (RNFL) thickness on optical coherence tomography correlated with intraocular pressure (IOP). There was a significant association between IOP and PMD (Spearman's rho = -0.863, p < .01) and between IOP and RNFL thickness (Spearman's rho = -0.630, p < .01). A higher IOP was associated with a greater functional loss in the VF and a reduction in the RNFL thickness. These results suggest that a clinical trial of IOP reduction should be considered in patients with ONHD to decrease the progression of optic nerve damage over time.
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Affiliation(s)
| | | | | | - Olinda Faria
- Ophthalmology Department, Centro Hospitalar São João, Oporto, Portugal.,Surgery and Physiology Department, Faculty of Medicine, Porto University, Oporto, Portugal
| | - F Falcão-Reis
- Ophthalmology Department, Centro Hospitalar São João, Oporto, Portugal.,Surgery and Physiology Department, Faculty of Medicine, Porto University, Oporto, Portugal
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Yan Y, Zhou X, Chu Z, Stell L, Shariati MA, Wang RK, Liao YJ. Vision Loss in Optic Disc Drusen Correlates With Increased Macular Vessel Diameter and Flux and Reduced Peripapillary Vascular Density. Am J Ophthalmol 2020; 218:214-224. [PMID: 32360344 DOI: 10.1016/j.ajo.2020.04.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 04/16/2020] [Accepted: 04/17/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE To determine the key optical coherence tomography (OCT) and OCT angiography (OCTA) parameters that correlate with visual field loss in optic disc drusen (ODD). DESIGN Retrospective cross-sectional study. METHODS Single academic center. Seventeen patients with ODD (29 eyes) and 35 age-matched controls (53 eyes). Static perimetry, OCT, and OCTA imaging of optic disc and macula. Static perimetry, OCT, and OCTA measurements. RESULTS We investigated the relationship between static perimetry and 14 OCT/OCTA measurements in patients with ODD vs age-matched controls and found 5 key measurements that most correlated with visual field loss included: peripapillary retinal nerve fiber layer (RNFL), macular ganglion cell complex (GCC), peripapillary vessel area density (VAD), macular vessel diameter (VD), and flux. Hierarchical clustering of these 5 measurements vs all clinical characteristics revealed 3 distinct clusters. ODD and control eyes with no visual field loss (mean deviation [MD] > -2.0 dB) had high RNFL and GCC, and low macular VD and flux. ODD eyes with mild visual field loss (MD -2.0 to -5.0 dB) had high RNFL, GCC, and increased macular VD and flux. ODD eyes with moderate/severe visual field loss (MD < -5.0 dB) had decreased RNFL, GCC, peripapillary VAD, and increased macular VD and flux. CONCLUSIONS OCT and OCTA provided objective measurements that can help predict visual field loss in ODD. Our data suggest that increased macular flow may be an early biomarker of visual field loss in ODD, while decreased peripapillary vessel density and RNFL thickness are late biomarkers of visual field loss in ODD.
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42
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Paez-Escamilla M, Jhingan M, Gallagher DS, Singh SR, Fraser-Bell S, Chhablani J. Age-related macular degeneration masqueraders: From the obvious to the obscure. Surv Ophthalmol 2020; 66:153-182. [PMID: 32971140 DOI: 10.1016/j.survophthal.2020.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 08/21/2020] [Accepted: 08/24/2020] [Indexed: 01/05/2023]
Abstract
Age-related macular degeneration (AMD) is one of the leading causes of blindness worldwide with increasing prevalence owing to increased life expectancy. Intravitreal injections of antivascular endothelial growth factor agents are commonly used in exudative AMD and oral antioxidant medication for nonexudative AMD; however, many disorders mimic exudative and nonexudative AMD, and misdiagnosis can seriously affect the management of these patients. We summarize the demographics and clinical and imaging characteristics of each of the conditions that masquerade as AMD. As some of the conditions have features of AMD, a short update on the classical features of AMD is also included.
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Affiliation(s)
- Manuel Paez-Escamilla
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Mahima Jhingan
- Jacobs Retina Center at Shiley Eye Center, University of California, San Diego, La Jolla, California, USA
| | - Denise S Gallagher
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Sumit Randhir Singh
- Jacobs Retina Center at Shiley Eye Center, University of California, San Diego, La Jolla, California, USA
| | | | - Jay Chhablani
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
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43
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Dai A, Malmqvist L, Rothenbuehler SP, Hamann S. OCT based interpretation of the optic nerve head anatomy in young adults with retinal vascular occlusions and ischemic optic neuropathy. Eur J Ophthalmol 2020; 31:2563-2570. [PMID: 32907397 DOI: 10.1177/1120672120957591] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To examine optic nerve head (ONH) anatomy in young adults with central retinal vein occlusion (CRVO), branch retinal vein occlusion (BRVO), central retinal artery occlusion (CRAO), branch retinal artery occlusion (BRAO) or nonarteritic anterior ischemic optic neuropathy (NA-AION) in order to look for associated, potentially predisposing anomalies. METHODS Cross-sectional study including 54 patients (ages 16-50 years) diagnosed from 2009 to 2018 with CRVO, BRVO, CRAO, BRAO, or NA-AION. Using Optical Coherence Tomography the presence of optic disc drusen (ODD), prelaminar hyperreflective lines and peripapillary hyperreflective ovoid mass-like structures (PHOMS), and determination of scleral canal size, retinal nerve fiber layer thickness (RNFLT) and macular ganglion cell layer thickness (GCLT) was obtained. Data for retinal vascular occlusion patients were grouped and analyzed together. RESULTS ODD were found in 13% of all patients, 2% of retinal vascular occlusion patients and 67% of NA-AION patients (p < 0.0001). Prelaminar hyperreflective lines were found in 35% of all patients, 24% of retinal vascular occlusion patients and 89% of NA-AION patients (p = 0.0005). PHOMS were found in 20% of all patients, 13% of retinal vascular occlusion patients and 56% of NA-AION patients (p = 0.012). RNFLT was decreased in ODD patients compared to patients without ODD (p = 0.01). Scleral canal diameter and GCLT was not correlated with ODD, prelaminar hyperreflective lines or PHOMS. CONCLUSION ODD, prelaminar hyperreflective lines and PHOMS were more frequent in NA-AION patients compared to retinal vascular occlusion patients. The prevalence of ODD in retinal vascular occlusion patients was similar to the reported prevalence in the general population.
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Affiliation(s)
- Amy Dai
- Department of Ophthalmology, Rigshospitalet, University of Copenhagen, Glostrup, Denmark
| | - Lasse Malmqvist
- Department of Ophthalmology, Rigshospitalet, University of Copenhagen, Glostrup, Denmark
| | - Simon P Rothenbuehler
- Department of Ophthalmology, Rigshospitalet, University of Copenhagen, Glostrup, Denmark.,Department of Ophthalmology, University Hospital Basel, Basel, Switzerland
| | - Steffen Hamann
- Department of Ophthalmology, Rigshospitalet, University of Copenhagen, Glostrup, Denmark
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44
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Steinhorst NA, Spitzer M, Skevas C. Bevacizumab as a treatment option for choroidal neovascularisation due to large optic nerve drusen in a 14-year-old girl. GMS OPHTHALMOLOGY CASES 2020; 10:Doc33. [PMID: 32884887 PMCID: PMC7452948 DOI: 10.3205/oc000160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Purpose: To report the effects of a single intravitreous injection of bevacizumab for the treatment of secondary choroideal neovascularisation due to large optic disc drusen. Methods: A 14-year-old female patient with painless loss of vision in one eye presented with unusually large optic disc drusen and juxtapapillary choroidal neovascularisation with subretinal hemorrhage. She was treated with a single intravitreous injection of bevacizumab. Results: Visual acuity increased from 20/100 to 20/25 within 4 weeks after injection and remained at this level during the 12-month follow-up period. Conclusions: Bevacizumab is a possible primary treatment option for secondary choroidal neovascularisation due to large optic disc drusen in children as an alternative to other more invasive or complex procedures.
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Affiliation(s)
| | - Martin Spitzer
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christos Skevas
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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45
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McTaggart JS, Lalou AD, Higgins NJ, Chitre M, Parker APJ, Muthusamy B, Czosnyka ZH, Krishnakumar D. Correlation between the total number of features of paediatric pseudotumour cerebri syndrome and cerebrospinal fluid pressure. Childs Nerv Syst 2020; 36:2003-2011. [PMID: 32123999 DOI: 10.1007/s00381-020-04537-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 02/08/2020] [Indexed: 12/29/2022]
Abstract
PURPOSE Accurate diagnosis of pseudotumour cerebri syndrome (PTCS) in children is challenging. We aimed to see if the clinical and radiological assessment that is carried out before lumbar puncture could predict subsequently recorded CSF pressures, and thus whether it could be used to increase diagnostic certainty of paediatric PTCS. METHODS We used internationally recognised diagnostic criteria to derive a list of clinical, brain neuroimaging and venography features that were accepted to be associated with a diagnosis of PTCS. We performed a retrospective cohort study of children referred to our centre with suspected PTCS, identifying the presence or absence of those features for each child at initial presentation. The sum total scores of the features that were present were correlated with the child's recorded CSF pressure. RESULTS The sum total scores were significantly positively correlated with recorded CSF pressures. The positive correlation was seen when clinical and brain neuroimaging features were included alone, and the correlation was slightly stronger when venography features were included in addition. CONCLUSION Calculating the sum total of clinical, brain neuroimaging and venography features (where venography is performed) present at initial presentation can help in the management of children under investigation for PTCS. Children with high scores are more likely to have severely raised CSF pressures and thus may warrant more urgent LP investigations. By contrast, in children with subtle abnormalities in optic disc appearance such that disc oedema cannot be ruled out, a low score may add further reassurance and less urgency to proceed to LP.
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Affiliation(s)
- James S McTaggart
- Paediatric Neurology, Department of Paediatrics, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK.
| | - Afroditi-Despina Lalou
- Clinical Neurosciences, Division of Neurosurgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK
| | - Nicholas J Higgins
- Neuroradiology, Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK
| | - Manali Chitre
- Paediatric Neurology, Department of Paediatrics, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK
| | - Alasdair P J Parker
- Paediatric Neurology, Department of Paediatrics, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK
| | - Brinda Muthusamy
- Paediatric Ophthalmology, Department of Ophthalmology, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK
| | - Zofia H Czosnyka
- Clinical Neurosciences, Division of Neurosurgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK
| | - Deepa Krishnakumar
- Paediatric Neurology, Department of Paediatrics, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK.
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Teixeira FJ, Marques RE, Mano SS, Couceiro R, Pinto F. Optic disc drusen in children: morphologic features using EDI-OCT. Eye (Lond) 2020; 34:1577-1584. [PMID: 31745329 PMCID: PMC7608464 DOI: 10.1038/s41433-019-0694-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 09/20/2019] [Accepted: 09/30/2019] [Indexed: 11/22/2022] Open
Abstract
AIMS This study aimed to investigate morphologic features of optic disc drusen (ODD) and peripapillary hyperreflective ovoid mass-like structures (PHOMS) in children, using enhanced depth imaging optical coherence tomography (EDI-OCT). It also assessed if the presence of these features were associated with decreased peripapillary retinal nerve fibre layer (RNFL) thickness. METHODS Retrospective observational study of children with ODD. All subjects underwent complete ophthalmic examination and multimodal imaging. ODD were identified on EDI-OCT as circumscribed hyporeflective spheroidal elements located in front of lamina cribrosa, fully or partially surrounded by a hyperreflective border. PHOMS were identified as hyperreflective ovoid structures located in the peripapillary circumference. Both associations between ODD and RNFL loss and PHOMS and RNFL loss were tested using chi-squared test. RESULTS In total, 38 eyes of 20 children were analysed. PHOMS were present in 90% of patients. ODD and PHOMS were predominantly found in the nasal, superonasal and inferonasal sectors. A significant positive association was found between ODD and decreased RNFL thickness in the nasal (p = 0.02), superonasal (p = 0.05) and inferotemporal (p = 0.04) sectors. There was no significant association found with the presence of PHOMS. CONCLUSION EDI-OCT allowed morphological analysis of ODD and PHOMS in children. Drusen were found to be distinct from PHOMS both in their appearance and impact on the RNFL. ODD are hyporeflective and appear on the ONH above the lamina cribrosa and were associated with decreased thickness of the RNFL. On the contrary, PHOMS are hyperreflective structures located around the ONH and were not associated with RNFL loss.
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Affiliation(s)
- Filipa Jorge Teixeira
- Hospital de Santa Maria, Lisboa, Portugal.
- Faculdade de Medicina, Clínica Universitária de Oftalmologia, Universidade de Lisboa, Lisboa, Portugal.
| | - Raquel Esteves Marques
- Hospital de Santa Maria, Lisboa, Portugal
- Faculdade de Medicina, Clínica Universitária de Oftalmologia, Universidade de Lisboa, Lisboa, Portugal
| | - Sofia Sousa Mano
- Hospital de Santa Maria, Lisboa, Portugal
- Faculdade de Medicina, Clínica Universitária de Oftalmologia, Universidade de Lisboa, Lisboa, Portugal
| | - Rita Couceiro
- Hospital de Vila Franca de Xira, Vila Franca de Xira, Portugal
| | - Filomena Pinto
- Hospital de Santa Maria, Lisboa, Portugal
- Faculdade de Medicina, Clínica Universitária de Oftalmologia, Universidade de Lisboa, Lisboa, Portugal
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Escobar Gómez HD, Jaramillo Velásquez DL, Cárdenas Angelone PL, Martínez Malo LK, Vélez Álvarez C. Coexistence of idiopathic intracranial hypertension and optic disc drusen in a latin american patient: case report. ARCHIVOS DE LA SOCIEDAD ESPAÑOLA DE OFTALMOLOGÍA 2020; 96:326-331. [PMID: 34092287 DOI: 10.1016/j.oftale.2020.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 06/08/2020] [Indexed: 11/25/2022]
Abstract
Optic nerve drusen are acellular concretions of calcium located in the parenchyma of the optical nerve head described as the most common cause of pseudo-papilloedema, which makes it difficult to differentiate from a true optical disc oedema. Despite it being rare, the drusen of the optic nerve and the papilloedema secondary to idiopathic intracranial hypertension can coexist in the same patient. The case is presented of a 34 year-old woman referred to the Ophthalmology Department with visual discomfort, headaches, and pulsatile tinnitus of two months onset. In the physical examination there was bilateral blurring of the optic disc margin with absence of spontaneous venous pulsation. The diagnosis of idiopathic intracranial hypertension was made by lumbar puncture with the measurement of the opening pressure, and due to the findings of the magnetic resonance scan of the brain and the eye sockets. The optic nerve drusen was an incidental finding in an optical coherence tomography angiography, which would later be confirmed with an eye ultrasound. To our knowledge, this the first case reported in Latin America of the coexistence of optic nerve drusen and papilloedema secondary to idiopathic intracranial hypertension.
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Affiliation(s)
- H D Escobar Gómez
- Departamento de Oftalmología, Fundación Oftalmológica de Santander FOSCAL, Floridablanca, Santander, Colombia; Departamento de Ciencias Para La Salud, Universidad de Caldas, Manizales, Colombia.
| | - D L Jaramillo Velásquez
- Departamento de Oftalmología, Fundación Oftalmológica de Santander FOSCAL, Floridablanca, Santander, Colombia
| | - P L Cárdenas Angelone
- Departamento de Oftalmología, Fundación Oftalmológica de Santander FOSCAL, Floridablanca, Santander, Colombia
| | - L K Martínez Malo
- Departamento de Oftalmología, Fundación Oftalmológica de Santander FOSCAL, Floridablanca, Santander, Colombia
| | - C Vélez Álvarez
- Departamento de Salud Pública, Universidad de Caldas, Manizales, Colombia
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Torres Ledesma B, Botella García J, Torres Pereda JP. Four-Year Outcome of Aflibercept for Peripapillary Choroidal Neovascularization Secondary to Optic Nerve Head Drusen in a Child. J Pediatr Ophthalmol Strabismus 2020; 57:e63-e67. [PMID: 32816045 DOI: 10.3928/01913913-20200527-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 04/02/2020] [Indexed: 11/20/2022]
Abstract
Choroidal neovascularization is an optic nerve head drusen complication that can lead to severe vision loss. There is no prior evidence of the efficacy of intravitreal aflibercept in children in such cases. The authors report the case of a boy who was successfully treated with aflibercept with benefits lasting up to 4 years. [J Pediatr Ophthalmol Strabismus. 2020;57:e63-e67.].
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Peripapillary hyperreflective ovoid mass-like structures-a novel entity as frequent cause of pseudopapilloedema in children. Eye (Lond) 2020; 35:1228-1234. [PMID: 32616868 DOI: 10.1038/s41433-020-1067-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 06/20/2020] [Accepted: 06/23/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Optic nerve head drusen (ONHD) are considered the most common cause for pseudopapilloedema in children. We aimed to investigate and further characterize a new type of optic nerve head lesion on enhanced depth imaging optical coherence tomography (EDI-OCT) named peripapillary hyperreflective ovoid mass-like structures (PHOMS), and ONHD in asymptomatic children with pseudopapilloedema. METHODS Retrospective cohort study including 64 eyes from 32 patients with pseudopapilloedema due to PHOMS and/or ONHD. Mean age was 9.0 ± 3.1 years. PHOMS and ONHD were identified and classified on EDI-OCT and infrared images. Ultrasound images were classified for the presence of hyperechogenic structures of the optic nerve head. RESULTS On EDI-OCT, PHOMS were detected in 63 out of 64 eyes (98.4%). In 60 eyes (93.8%), small hyperreflective foci inside the PHOMS were present. In all cases, we identified a new ring sign visible on infrared images, corresponding clearly to the edge of the PHOMS as seen on EDI-OCT. On ultrasound, we describe a new feature of PHOMS appearing as small hyperechogenic structures without posterior shadowing. In 13 eyes (20.3%), ONHD were present on EDI-OCT and ultrasound. CONCLUSION This is the first study showing that PHOMS are the most common cause for pseudopapilloedema in children. PHOMS is a new entity of optic nerve head lesions. It might be a precursor of buried optic nerve head drusen, which can lead to visual field defects, haemorrhages and CNV. This study offers new tools to identify and follow-up these lesions early in childhood using EDI-OCT.
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Ortega CM, Daroni M, Maggi M, Pratto DE, Irungaray JI, Weskamp RF. Juxtapapillary neovascular membrane associated with optic nerve drusen. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2020; 95:279-283. [PMID: 32376128 DOI: 10.1016/j.oftal.2020.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 03/22/2020] [Accepted: 03/24/2020] [Indexed: 06/11/2023]
Abstract
CLINICAL CASE Forteen year old patient presenting progressive decrease in visual acuity of the left eye after 3 months of evolution. On examination he presents bilateral drusen of papilla, associated with juxtapapillary neovascular membrane, which seriously compromises the vision and visual field of the left eye. RESULT Treatment with 3 consecutive injections of intravitreal ranibizumab resulted in the inactivation of the neovascular membrane with reabsorption of subretinal fluid and improvement of the best corrected visual acuity of the left eye. After 9 months of follow-up, it was 20/20 and stable. CONCLUSION Although optic nerve head drusen are considered benign, neovascular membranes can be a complication. Anti-VEGFs are an effective alternative for treatment.
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Affiliation(s)
- C M Ortega
- Servicio de Oftalmología, Consultorios oftalmológicos Dr. Carlos Miguel Ortega, Banfield, Buenos Aires, Argentina
| | - M Daroni
- Servicio de Oftalmología, Centro de Ojos Flores, Buenos Aires, Argentina
| | - M Maggi
- Servicio de Oftalmología, Centro de Ojos Lanús, Lanús, Buenos Aires, Argentina
| | - D E Pratto
- Servicio de Oftalmología, Centro de Ojos Lanús, Lanús, Buenos Aires, Argentina.
| | - J I Irungaray
- Servicio de Oftalmología, Centro de Ojos Lanús, Lanús, Buenos Aires, Argentina
| | - R F Weskamp
- Servicio de Oftalmología, Centro de Ojos Lanús, Lanús, Buenos Aires, Argentina
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