合并视盘周围强反射卵圆形肿块样结构的儿童假性视乳头水肿患者临床特征  

Clinical characteristics of pseudopapilledema combined with peripapillary hyper-reflective ovoid mass-like structures in children

作　　者：蔺雪梅[1] 刘佩 王静 常乔乔 陆慧琴[2] 赵隽 吴松笛[1] Lin Xuemei;Liu Pei;Wang Jing;Chang Qiaoqiao;Lu Huiqin;Zhao Jun;Wu Songdi(Department of Neuro-ophthalmology,The First Hospital of Xi'an,Affiliated of The First Hospital of Northwest University,Xi’an 710002,China;Department of Ophthalmology,The First Hospital of Xi’an,Affiliated of The First Hospital of Northwest University,Xi’an 710002,China)

机构地区：[1]西安市第一医院(西北大学附属第一医院)神经眼科,西安710002 [2]西安市第一医院(西北大学附属第一医院)眼科,西安710002

出　　处：《中华眼底病杂志》2023年第7期569-575,共7页Chinese Journal of Ocular Fundus Diseases

基　　金：陕西省科技计划项目(2022SF-381、2023-YBSF-048);陕西省中医药管理局项目(2022-SLRH-LJ-013);陕西省卫健委项目(2022C005)。

摘　　要：目的观察儿童假性视乳头水肿(PPE)合并视盘周围强反射卵圆形肿块样结构(PHOMS)患者的临床及光相干断层扫描(OCT)影像特征。方法回顾性观察研究。2019年10月至2021年5月于西安市第一医院(西北大学附属第一医院)神经眼科检查确诊的PPE合并PHOMS儿童患者12例22只眼纳入研究。其中,男性6例,女性6例;年龄(10.6±2.7)岁。发病至确诊PPE合并PHOMS的病程为(8.0±7.5)个月。患眼均行最佳矫正视力(BCVA)、相对性传入瞳孔功能障碍(RAPD)、色觉、眼底彩色照相、OCT、眼底自身荧光(FAF)、眼B型超声、视野、图形视觉诱发电位(P-VEP)检查。观察患者临床和OCT影像特征。结果患眼眼前节均未见明显异常;眼压、色觉正常;RAPD阴性。22只眼中,BCVA 1.0者21只眼;0.12者1只眼。眼底视盘边界模糊,呈轻度至中度隆起,鼻侧隆起更为显著,呈"C"形光晕。FAF未见明显异常荧光。OCT检查,可见视盘不同程度隆起;连续视盘鼻侧扩大扫描,可见与眼底彩色照相视盘周围鼻侧隆起对应部位侧向突入视网膜神经纤维层下、Bruch膜上,边界清晰卵圆形稍强反射结构,且隆起程度越高其体积相对越大。黄斑区视网膜色素上皮层及神经节细胞层厚度均未见明显异常。B型超声检查,所有患眼均可见眼球后壁视神经头(视盘前)隆起结构,其内无强信号回声。视野检查,存在生理盲点扩大3只眼,视野缺损2只眼。P-VEP检查,存在波峰略延迟3只眼,波幅值轻度降低3只眼。结论OCT扩大鼻侧视盘扫描可提高PHOMS检出率。双眼PPE者双眼均存在PHOMS,单眼PPE者仅患眼存在PHOMS;PPE程度越高,PHOMS体积相对越大。PHOMS有助于儿童PPE的诊断。Objective To observe the clinical characteristics and optical coherence tomography(OCT)features of pseudopapilledema(PPE)combined with peripapillary hyper-reflective ovoid mass-like structures(PHOMS)in children.Methods A retrospective observational study.From October 2019 to May 2021,total 22 eyes from 12 children diagnosed as PPE combined with PHOMS in the Neuro-ophthalmology Department of The First Hospital of Xi’an(Affiliated of The First Hospital of Northwest University)were recruited.Among the children,6 were male and 6 were female.The average age was(10.6±2.7)years.The average course from disease onset to diagnosis of PPE combined with PHOMS was(8.0±7.5)months.All patients underwent best corrected visual acuity(BCVA),relative afferent papillary defect(RAPD),Ishihara's test,fundus photography,OCT,fundus autofluorescence(FAF),ocular B-mode ultrasound,visual field and patternvisual evoked potential(P-VEP).The clinical and OCT characteristics of the patients were observed.Results The anterior segments of the patients were normal.The intraocular pressures and Ishihara's test were all normal.All RAPD were negative.Total 22 eyes,BCVA was 1.0 in 21 eyes and one eye was 0.12.The fundus photography revealed blurred optic discs margin,showing mild to moderate edema-like elevation with more prominent in the nasal parts,presenting as a"C"shape halo.No obvious abnormal fluorescence was observed in FAF.The OCT scan of involvement eyes showed an elevated appearance in vary degrees,and the sharply marginated ovoid hyper-reflective mass-like structures which laterally herniated into the peripapillary region under retinal nerve fiber layer and above the Bruch membrane were detected with consecutive nasal enlargement scanning,corresponding to the nasal parts in the fundus photography.The higher degree of elevation,the larger the volume.Macular retina pigment epithelium layer and ganglion cell thickness were normal.Ocular B-mode ultrasound showed that the head of the optic nerve in the posterior wall of the eyeball(in front

关 键 词：假性视乳头水肿 视盘周围高反射卵圆形肿块样结构 视盘玻璃疣 体层摄影术 光学相干 

分 类 号：R774.1[医药卫生—眼科]