Optical coherence tomography manifestations of the acute papilledema in patients with acquired immunodeficiency syndrome complicated with cryptococcal meningitis

doi:10.3877/cma.j.issn.1674-1358.2021.04.009

Abstract

Abstract:

Objective

To investigate the acute papilledema by measuring the peripapillary retinal nerve fiber layer thickness (RNFLT) changes and its morphology in patients with acquired immunodeficiency syndrome (AIDS) complicated with cryptococeal neoformans menin-gitis (CNM).

Methods

The ophthalmic manifestations of the 30 patients (57 eyes) diagnosed as AIDS complicated with CNM from May 2009 to October 2018 were analyzed in Beijing Ditan Hospital, Capital Medical University, retrospectively, and were divided into two groups according to the situation of fundus: 15 patients (30 eyes) with normal fundus as control group and 15 patients (27 eyes ) of papilledema with intracranial hypertension as observation group. The mean thickness of peripapillary retinal nerve fiber layer (RNFLT) in upper, lower, nasal and temporal quadrants at 3.4 mm around optic disc was measured by spectral domain optical coherence tomography (SD-OCT), and the angle of retinal pigment epithelial Bruch’s membrane (RPE/BM) at the temporal and nasal edges of the neural tube opening and the morphology of the elongation line was estimated roughly.

Results

The average age of the control group and observation group [(36.5 ± 12.3) years old vs. (30.2 ± 9.1) years old; t = 1.588, P = 0.298)], gender (12/3 vs. 13/2, P = 1.000), AIDS diagnosis period [(4.90 ± ?.??) years vs. (4.06 ± 2.37) years; t = 0.906, P = 0.543], IOP [(12 ± 3) mmHg vs. (13 ± 4) mmHg; t =-0.815, P = 0.362] and the best corrected visual acuity [(0.85 ± 0.15) vs. (0.81 ± 0.17); t = 0.690, P = 0.853] were all without significant differences. The mean RNFLT of peripapillary and the four quadrants of patients in control group and observation group all had a statistical significance (P < 0.001). During control group, 23 eyes of 30 eyes (76.7%) had negative angle with outward angulation ( "V" shape), while in observation group, 16 eyes of 27 eyes (59.3%) had positive angle with inward angulation ( "inverted U" shape).

Conclusions

The peripapillary RNFLT in patients with papilledema were significantly thickened than the normal group. The characteristic morphological positive angle ( "inverted U" shape) and negative angle ( "V" shape) formed at the RPE/BM at the opening of the optic canal were all effective methods to identify papilledema.

Key words: Acquired immune deficiency syndrome, Cryptococeal neoformans meningitis, Peripapillary, Cranial hypertension, Spectral domain-optical coherence tomography

Dan Lu, Feifei Mao, Dan Li, Shengnan Wang, Xiyao Liu, Huiyu Sun. Optical coherence tomography manifestations of the acute papilledema in patients with acquired immunodeficiency syndrome complicated with cryptococcal meningitis[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2021, 15(04): 270-275.

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References 25

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组别	例数	眼睛数（只）	RNFLT
组别	例数	眼睛数（只）	平均值	上方	下方	鼻侧	颞侧
对照组	15	30	108.10 ± 33.60	141.60 ± 12.68	134.20 ± 17.93	82.30 ± 14.14	74.30 ± 13.28
观察组	15	27	227.07 ± 82.88	280.64 ± 86.48	267.92 ± 75.71	184.93 ± 59.14	174.79 ± 51.05
t值			-9.69	-5.92	-6.36	-6.25	-7.01
P值			< 0.001	< 0.001	< 0.001	< 0.001	< 0.001

组别	例数	眼睛数（只）	RNFLT
组别	例数	眼睛数（只）	平均值	上方	下方	鼻侧	颞侧
对照组	15	30	108.10 ± 33.60	141.60 ± 12.68	134.20 ± 17.93	82.30 ± 14.14	74.30 ± 13.28
观察组	15	27	227.07 ± 82.88	280.64 ± 86.48	267.92 ± 75.71	184.93 ± 59.14	174.79 ± 51.05
t值			-9.69	-5.92	-6.36	-6.25	-7.01
P值			< 0.001	< 0.001	< 0.001	< 0.001	< 0.001

组别	例数	眼睛数（只）	RPE/BM夹角[只（%）]
组别	例数	眼睛数（只）	负角（"V"形）	0角（水平）	正角（"倒U"形）
对照组	15	30	23（76.7）	6（20.0）	1（3.3）
观察组	15	27	3（11.1）	8（29.6）	16（59.3）
χ²值			28.828
P值			< 0.001

组别	例数	眼睛数（只）	RPE/BM夹角[只（%）]
组别	例数	眼睛数（只）	负角（"V"形）	0角（水平）	正角（"倒U"形）
对照组	15	30	23（76.7）	6（20.0）	1（3.3）
观察组	15	27	3（11.1）	8（29.6）	16（59.3）
χ²值			28.828
P值			< 0.001

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