June 2017
Volume 58, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2017
Ultrasonography, OCT and OCT-angiography in the diagnostic workup of children with suspected papilledema
Author Affiliations & Notes
  • Annegret H Dahlmann-Noor
    Paediatric Ophthalmology and Strabismus, NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, Greater London, United Kingdom
  • Gillian GW Adams
    Paediatric Ophthalmology and Strabismus, Moorfields Eye Hospital, London, United Kingdom
  • Moritz C Daniel
    Paediatric Ophthalmology and Strabismus, NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, Greater London, United Kingdom
  • Alison Davis
    Paediatric Ophthalmology and Strabismus, Moorfields Eye Hospital, London, United Kingdom
  • Joanne Hancox
    Paediatric Ophthalmology and Strabismus, Moorfields Eye Hospital, London, United Kingdom
  • Melanie Hingorani
    Paediatric Ophthalmology and Strabismus, Moorfields Eye Hospital, London, United Kingdom
  • Patricia Ibanez
    Medical Illustration, Moorfields Eye Hospital, London, United Kingdom
  • Becky MacPhee
    Medical Illustration, Moorfields Eye Hospital, London, United Kingdom
  • Himanshu Patel
    Paediatric Ophthalmology and Strabismus, Moorfields Eye Hospital, London, United Kingdom
  • Marie Restori
    Ocular ultrasound, Moorfields Eye Hospital, London, United Kingdom
  • Clare Roberts
    Paediatric Ophthalmology and Strabismus, Moorfields Eye Hospital, London, United Kingdom
  • John Sloper
    Paediatric Ophthalmology and Strabismus, Moorfields Eye Hospital, London, United Kingdom
  • Maria Theodorou
    Paediatric Ophthalmology and Strabismus, Moorfields Eye Hospital, London, United Kingdom
  • James Acheson
    Neuro-ophthalmology, Moorfields Eye Hospital, London, Greater London, United Kingdom
  • Footnotes
    Commercial Relationships   Annegret Dahlmann-Noor, None; Gillian Adams, None; Moritz Daniel, None; Alison Davis, None; Joanne Hancox, None; Melanie Hingorani, None; Patricia Ibanez, None; Becky MacPhee, None; Himanshu Patel, None; Marie Restori, None; Clare Roberts, None; John Sloper, None; Maria Theodorou, None; James Acheson, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2017, Vol.58, 3304. doi:
  • Views
  • Share
  • Tools
    • Alerts
      ×
      This feature is available to Subscribers Only
      Sign In or Create an Account ×
    • Get Citation

      Annegret H Dahlmann-Noor, Gillian GW Adams, Moritz C Daniel, Alison Davis, Joanne Hancox, Melanie Hingorani, Patricia Ibanez, Becky MacPhee, Himanshu Patel, Marie Restori, Clare Roberts, John Sloper, Maria Theodorou, James Acheson; Ultrasonography, OCT and OCT-angiography in the diagnostic workup of children with suspected papilledema. Invest. Ophthalmol. Vis. Sci. 2017;58(8):3304.

      Download citation file:


      © ARVO (1962-2015); The Authors (2016-present)

      ×
  • Supplements
Abstract

Purpose : Optic nerve sheath dilatation (ONSD) on ocular ultrasound (US) is considered a sensitive and specific indicator of raised intracranial pressure (ICP). Anterior bowing of Bruch membrane (AB-BM) and increase in retinal nerve fibre layer thickness (RNFLT) in superonasal, nasal or temporal sector (SN, N, T) on optical coherence tomography (OCT) may be of similar diagnostic value. OCT-angiography (OCT-A) has not been evaluated in this context. This retrospective observational study explores diagnostic accuracy of US, OCT and OCT-A in children referred for suspected optic nerve head swelling.

Methods : 61 cases assessed over a seven-month period in 2016 at a single centre in London, UK; 26 girls (43%); median age 10.9 years (interquartile range 7.9 to 13). A masked observer collated imaging and clinical data. We calculated specificity and sensitivity for each test; for RNFLT we used published cutoffs as indicators for true optic disc edema: SN: 124, N: 78/74.5, T: 101.5um.

Results : Of 61 cases, three had intracranial pathology: intraventricular tumour (IVT), hypophosphataemic rickets with neuro-imaging signs of chronic raised ICP, and relapse of acute lymphoblastic leukaemia (ALL). All three had symptoms or significant history.
At initial presentation, only one of these three cases had ONSD on ultrasound (sensitivity 33%, specificity 100%). AB-BM had similar accuracy (sensitivity 33%, specificity 96.6%). Increased RNFLT (Fig 1) had higher sensitivity (66.7%), but lower specificity (42.1 to 86%). In all three cases, OCT-A delivered unclear images and could not perform automated measurements of peripapillary vessel density.

Conclusions : In children, ocular ultrasound and OCT alone are not sufficiently accurate to discard the possibility of intracranial pathology. Previous studies have reported that 36.4 to 48% of children with brain tumors or idiopathic intracranial hypertension may not develop papilledema. History and basic neurological assessment remain critical in the diagnostic workup of children with suspected intracranial pathology.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.

 

Fig 1. RNFLT (um) superonasal, nasal and temporal sector (right eyes). Case 23 (ALL) had markedly increased RNFLT in the superonasal and nasal sectors. Case 31 (IVT) had marked increase in RFNLT in the temporal sector only. Case 29 (rickets) had no RNFLT increase. Green lines: previously published thresholds for “true papilledema”.

Fig 1. RNFLT (um) superonasal, nasal and temporal sector (right eyes). Case 23 (ALL) had markedly increased RNFLT in the superonasal and nasal sectors. Case 31 (IVT) had marked increase in RFNLT in the temporal sector only. Case 29 (rickets) had no RNFLT increase. Green lines: previously published thresholds for “true papilledema”.

×
×

This PDF is available to Subscribers Only

Sign in or purchase a subscription to access this content. ×

You must be signed into an individual account to use this feature.

×