Role of Ocular Ultrasonography to Distinguish Papilledema From Pseudopapilledema

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Title Role of Ocular Ultrasonography to Distinguish Papilledema From Pseudopapilledema
Creator Anita A. Kohli; Maxwell Pistilli; Cesar Alfaro; Ahmara G. Ross; Imran Jivraj; Sheila Bagchi; Jessie Chan; Dionne May; Grant T. Liu; Kenneth S. Shindler; Madhura A. Tamhankar
Affiliation Department of Ophthalmology and Visual Science (AAK), Yale University School of Medicine, New Haven, Connecticut; Department of Ophthalmology (MP), Center for Preventative Ophthalmology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Ophthalmology (CA), Icahn School of Medicine at Mount Sinai, New York, New York; Scheie Eye Institute (AGR, GTL, KSS, MAT), Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Ophthalmology (IJ), University of Alberta, Edmonton, Canada; Department of Medicine (SB), Temple University, Philadelphia, Pennsylvania; Rutgers Robert Wood Johnson Medical School (JC), Piscataway, New Jersey; Boston University Henry M. Goldman School of Dental Medicine (DM), Boston, Massachusetts; and Department of Neurology (GTL), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Abstract Background: We prospectively evaluated the sensitivity and specificity of ocular ultrasonography (OUS) to distinguish papilledema from pseudopapilledema. Methods: Forty-nine study participants, with optic disc elevation, underwent neuro-ophthalmic evaluation, OUS, fundus photography, and optical coherence tomography (OCT) of the optic nerve head at the initial and follow-up visits (≤6 months apart). Participants were classified as having papilledema if there was a change in optic nerve appearance on fundus photographs, as determined by a masked observer, between initial and follow-up visits ≤6 months apart. OUS was considered positive when the optic nerve sheath width was >3.3 mm and the 30° test was positive. Ocular ultrasonographic findings were correlated in patients who had papilledema vs patients who had pseudopapilledema. In a subanalysis, OUS findings were also correlated with change in peripapillary retinal nerve fiber layer thickness on OCT of the optic nerve head between initial and follow-up visits. Results: OUS was 68% (17/25) sensitive for papilledema and 54% (13/24) specific for pseudopapilledema. When using OCT parameters to define papilledema, the sensitivity of OUS to diagnose papilledema decreased to 62%. Positive OUS correlated with elevated opening pressure on lumbar puncture and with signs of increased intracranial pressure on MRI. Conclusion: OUS alone was less sensitive in diagnosing papilledema than previously thought. Therefore, OUS may not be helpful in distinguishing between papilledema and pseudopapilledema.
Subject Differential Diagnosis; Hereditary Eye Diseases; Follow-Up Studies; Optic Disk; Optic Nerve Diseases; Papilledema; Prospective Studies; ROC Curve; Optical Coherence Tomography; Ultrasonography
OCR Text Show
Date 2021-06
Language eng
Format application/pdf
Type Text
Publication Type Journal Article
Source Journal of Neuro-Ophthalmology, June 2021, Volume 41, Issue 2
Collection Neuro-Ophthalmology Virtual Education Library: Journal of Neuro-Ophthalmology Archives: https://novel.utah.edu/jno/
Publisher Lippincott, Williams & Wilkins
Holding Institution Spencer S. Eccles Health Sciences Library, University of Utah
Rights Management © North American Neuro-Ophthalmology Society
ARK ark:/87278/s62g6yh7
Setname ehsl_novel_jno
ID 1996635
Reference URL https://collections.lib.utah.edu/ark:/87278/s62g6yh7
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