Neuro-Ophthalmic Literature Review

Abstract

Neuro-Ophthalmic Literature Review David A. Bellows, John J. Chen, Hui-Chen Cheng, Panitha Jindahra, Collin McClelland, Michael S. Vaphiades, and Xiaojun Zhang The Medical Eye Center, Manchester, New Hampshire, USA; Departments of Ophthalmology and Neurology, Mayo Clinic, Rochester, MN, USA; Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Ophthalmology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Neurology, Mahidol University, Bangkok, Thailand; Department of Ophthalmology, University of Minnesota, Minneapolis, MN, USA; Departments of Ophthalmology, Neurology, and Neurosurgery, UAB Callahan Eye Hospital, Birmingham, AL, USA; Department of Neurology, Ohio State University Medical Center, Ohio, USA; Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing, China Oral fluorescein angiography for the diagnosis of papilloedema versus pseudopapilledema in children Elhusseiny AM, Fong JW, Hsu C, Grigorian F, Grigorian AP, Soliman MK, et al. Oral fluorescein angiography for the diagnosis of papilloedema versus pseudopapilledema in children. Am J Ophthalmol 2023;245: 8–13. This study was designed to determine if the use of oral fluorescein angiography is accurate and safe in differentiating papilloedema from pseudopapilloedema in paediatric patients. Two masked specialists (a paediatric ophthalmologist and retina specialist) reviewed the oral fluorescein angiogram images of 45 patients (90 eyes). They evaluated the optic discs and assigned them to three categories: leakage; no leakage; or “borderline” leakage of fluorescein, at least 30 minutes following ingestion of the medication. The determinations made by the masked observers were then compared with the final clinical diagnosis. There was excellent interobserver accordance in grading the images. Oral fluorescein angiography was found to be safe with no ocular, systemic or allergic reactions. The accuracy, however, was suboptimal with only 62 to 69% of images accurately differentiating papilloedema from pseudopapilloedema. However, the sensitivity at detecting leakage increased with the severity of disc swelling and the observers correctly identified papilloedema in 89% of patients who had Frisén grade 2 or 3 swelling. David Bellows Enhanced depth imaging may be the new gold standard for detecting optic disc drusen Youn S, Mfe B, Armstrong JJ, Fraser JA, Hamann S, Bursztyn L. Am J Ophthalmol. 11 December 2022: S0002-9394(22)00485–8. doi: 10.1016/j.ajo.2022. 12.004. Online ahead of print.