title: Retrospective analysis of translaminar, demographic, and physiologic parameters in relation to papilledema severity.
abstract: OBJECTIVE
  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
  Retrospective, blinded study.
  
  
  METHODS
  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 in the study. One-hundred and fifty-one patients were identified in initial screening. Sixty of 151 patients met all inclusion criteria, and 120 eyes were eligible for investigation.
  
  
  METHODS
  A retrospective review of optic nerve photographs by 2 masked experts was used to grade papilledema severity using the Modified Frisén Scale (MFS). Patients with any systemic or neurologic disease that could affect cerebrospinal fluid pressure (CSFP) were excluded. Patients on acetazolamide were excluded. Assessments within 1 MFS grade were averaged and correlated to intraocular pressure, CSFP, translaminar pressure differential, MFS, age, weight, height, and systolic and diastolic blood pressure.
  
  
  RESULTS
  In univariate and multivariate type 3 generalized estimating equation 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 CSFP, intraocular pressure, blood pressure, or any other physiologic parameter. Factors other than the translaminar pressure differential may be important in determining the severity of papilledema.
authors.affiliation: Department of Ophthalmology, University of North Carolina Hospitals, Chapel Hill, North Carolina. Electronic address: david8fleischman@gmail.com.
authors.forename: David
authors.initials: D
authors.lastname: Fleischman
authors.affiliation: Department of Ophthalmology, Brown University, Providence, Rhode Island.
authors.forename: Jennifer T
authors.initials: JT
authors.lastname: Perry
authors.affiliation: Duke University Eye Center, Durham, North Carolina.
authors.forename: R
authors.initials: R
authors.lastname: Rand Allingham
authors.affiliation: Duke University Eye Center, Durham, North Carolina.
authors.forename: Sandra S
authors.initials: SS
authors.lastname: Stinnett
authors.affiliation: Department of Otolaryngology, Head & Neck Surgery, University of North Carolina Hospitals, Chapel Hill, North Carolina.
authors.forename: Gita M
authors.initials: GM
authors.lastname: Fleischman
authors.affiliation: Raleigh Neurology Associates, Raleigh, North Carolina.
authors.forename: Syndee J
authors.initials: SJ
authors.lastname: Givre
authors.affiliation: Department of Ophthalmology, University of North Carolina Hospitals, Chapel Hill, North Carolina.
authors.forename: David A
authors.initials: DA
authors.lastname: Chesnutt
mesh_terms: D000328:Adult; D017677:Age Distribution; D015170:Cerebrospinal Fluid Pressure / Q000502:physiology*; D005260:Female; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D009898:Optic Disk / Q000000981:diagnostic imaging*; D010211:Papilledema / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D011559:Pseudotumor Cerebri / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D017678:Sex Distribution; D013129:Spinal Puncture