Abstract
Purpose :
Some case reports suggest that the translaminar pressure difference is important in cases of papilledema. The purpose of this study was to determine ocular, physiologic and demographic factors associated with papilledema severity.
Methods :
A retrospective review of optic nerve photographs by two masked experts was used to grade papilledema severity using the Modified Frisén Scale (MFS). Patients who had undergone a diagnostic lumbar puncture and had a diagnosis of papilledema in conjunction with idiopathic intracranial hypertension between 2004 and 2012 were included for analysis. Those with any systemic or neurologic disease that could affect CSFP were excluded. Patients on acetazolamide were excluded. Assessments within one MFS grade were averaged and correlated to intraocular pressure, cerebrospinal fluid pressure, translaminar pressure differential, Modified Frisen Score, age, weight, height, and systolic and diastolic blood pressure.
Results :
Sixty of 151 patients met all inclusion criteria, and 120 eyes were eligible for investigation. In univariate and multivariate type 3 generalized estimating equation (GEE) analyses, only age (Z: -2.70, p<0.01) and sex (Z=2.81; p<0.0001) were significantly correlated with MFS.
Conclusions :
Papilledema severity decreased with advancing age, and was higher for female sex. We found no association between severity of papilledema and cerebrospinal fluid pressure (CSFP), intraocular pressure (IOP), blood pressure, or any other physiologic parameter. Factors other than the translaminar pressure differential may be important in determining the severity of papilledema. A controlled prospective study is needed to validate these results.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.