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首页> 外文期刊>BMC Ophthalmology >Neurophthalmological conditions mimicking glaucomatous optic neuropathy: analysis of the most common causes of misdiagnosis
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Neurophthalmological conditions mimicking glaucomatous optic neuropathy: analysis of the most common causes of misdiagnosis

机译：模仿青光眼性视神经病变的神经眼科疾病：最常见的误诊原因分析

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Background To analyze the most common neurophthalmological conditions that may mimic glaucomatous optic neuropathy and to determine which most often lead to misdiagnosis when evaluated by a glaucoma specialist. Methods We reviewed the charts of consecutive patients with optic neuropathies caused by neurophthalmological conditions screened in a single Eye Clinic within a period of 24?months. Within these enrolled patients, we selected the eyes whose fundoscopic appearance could resemble glaucoma based in pre-defined criteria (vertical cup-to-disc ratio?≥0.6, asymmetry of the cup-to-disc ratio?≥0.2 between eyes, presence of localized retinal nerve fiber layer and/or neuroretinal rim defects, and disc haemorrhages). Then, color fundus photographs and Humphrey Visual Field tests (HVF) of these eyes were mixed with tests from 21 consecutive glaucomatous patients (42 eyes with normal tension glaucoma). These images were mixed randomly and a masked glaucoma specialist was asked to distinguish if each set of exams was from a patient with glaucoma or with a neurophthalmologic condition. Results Among the 101 eyes (68 patients) enrolled with neurophthalmological diseases, 16 (15.8%) were classified as conditions that could mimic glaucoma. The most common diagnoses were ischemic optic neuropathy (25%), compressive optic neuropathy (18.7%) and hereditary optic neuropathy (18.7%). Based on the analysis of fundus photographs and HVF tests, 25% of these were misdiagnosed as glaucoma (two ischemic optic neuropathies and two congenital optic disc anomalies). Conversely, 11.9% of the glaucomatous neuropathies were misdiagnosed as neurophthalmological disorders. Overall, the glaucoma specialist correctly diagnosed 84.5% of the eyes. Conclusions Some neurophthalmological disorders can mimic glaucoma. In our study, isquemic and compressive optic neuropathies were the ones that most often did so. Almost one quarter of the eyes were misdiagnosed when evaluated by a glaucoma specialist, which can lead to inadequate management and influence the prognosis of these patients.
机译：背景技术分析可能模拟青光眼性视神经病变的最常见的神经眼科疾病，并确定由青光眼专家评估时最常导致误诊的疾病。方法我们回顾了连续24个月内在单个眼科诊所筛查的由神经眼科疾病引起的连续视神经病变患者的病历表。在这些入选患者中，我们根据预先定义的标准（垂直杯碟比≥0.6，两眼之间杯碟不对称≥0.2，不存在眼底）选择了眼底镜外观类似于青光眼的眼睛。局部视网膜神经纤维层和/或神经视网膜边缘缺损，以及椎间盘出血。然后，将这些眼睛的彩色眼底照片和汉弗莱视野测试（HVF）与连续21例青光眼患者（42眼具有正常张力的青光眼）进行的检查相混合。将这些图像随机混合，并要求戴面具的青光眼专家区分每组检查是来自青光眼患者还是神经眼科疾病患者。结果在101例眼科疾病（68例）中，有16例（15.8％）被归类为可模拟青光眼的疾病。最常见的诊断是缺血性视神经病变（25％），压迫性视神经病变（18.7％）和遗传性视神经病变（18.7％）。根据对眼底照片和HVF测试的分析，其中25％被误诊为青光眼（两个缺血性视神经病变和两个先天性视盘异常）。相反，青光眼性神经病中有11.9％被误诊为神经眼科疾病。总体而言，青光眼专家正确诊断出84.5％的眼睛。结论某些神经眼科疾病可模仿青光眼。在我们的研究中，等距和压迫性视神经病变最常发生。由青光眼专家评估时，近四分之一的眼睛被误诊，这可能导致管理不当并影响这些患者的预后。

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