Sara N Reggie1, Robert A Avery2,3, James C Bavinger2, Imran Jivraj4, Cesar Alfaro5, Maxwell Pistilli6, Anita A Kohli7, Grant T Liu2,3, Kenneth S Shindler2, Ahmara G Ross2, Randy H Kardon8, Patrick A Sibony9, Madhura Tamhankar2. 1. Department of Ophthalmology, University of Tennessee Health Sciences Center, 930 Madison Ave #200, Memphis, TN, 38103, USA. snreggie@gmail.com. 2. Department of Neuro-ophthalmology, Departments of Ophthalmology and Neurology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA. 3. Neuro-ophthalmology Service, Division of Ophthalmology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA. 4. Department of Ophthalmology and Visual Sciences, University of Alberta, 2319 Active Treatment Centre, 10240 Kingsway Avenue NW, Edmonton, AB, T5H 3V9, Canada. 5. Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY, 10029-5674, USA. 6. Center for Preventive Ophthalmology and Biostatistics, University of Pennsylvania, 3711 Market Street, Suite 801, Philadelphia, PA, 19103, USA. 7. Department of Ophthalmology and Visual Science, Yale School of Medicine, 40 Temple Street, Suite 1B, New Haven, CT, 06510, USA. 8. Department of Ophthalmology and Visual Sciences, University of Iowa Carver College of Medicine, And Iowa City VA Healthcare System, 11290D PFP, Iowa City, IA, 52242, USA. 9. Department of Ophthalmology, State University of New York at Stony Brook, University Hospital and Medical Center, Stony Brook, New York, 11794, USA.
Abstract
PURPOSE: To determine if the presence or absence of retinal and choroidal folds on SD-OCT imaging can distinguish between mild papilloedema and pseudopapilledema. DESIGN: Cross-sectional cohort study METHODS: Subjects with optic disc elevation (Frisen grades 1 and 2 only) were eligible to be enrolled prospectively. Pseudopapilledema was defined as a lack of change in optic disc appearance between two visits <6 months apart, and papilloedema was defined as change in optic disc appearance between two visits <6 months apart determined by review of fundus photographs by a masked neuro-ophthalmologist. Three masked neuro-ophthalmologists independently reviewed en face and axial optical coherence tomography (OCT) images of the optic nerve of the study subjects for the presence or absence of retinal and choroidal folds. Concordance was determined when there was agreement between at least 2 of the 3 observers. RESULTS: Forty-five subjects (78 eyes) met inclusion criteria. There were 32 eyes with papilloedema and 46 eyes with pseudopapilledema. Choroidal and/or retinal folds were detected in 38% of eyes (12/32) with papilloedema and 19.6% of eyes (9/46) with pseudopapilledema. Post-hoc analyses eliminated six questionable cases of pseudopapilledema that had ancillary testing suggestive of elevated intracranial pressure and resulted in one remaining eye (2%) with more certain pseudopapilledema that was found to have folds. En face OCT imaging was more sensitive (71%) in detection of folds than axial OCT imaging (57%). CONCLUSIONS: Choroidal and/or retinal folds on OCT are commonly observed in patients with mild papilloedema and are uncommon in those with pseudopapilledema. The presence of folds on OCT in patients presenting with disc elevation suggests papilloedema.
PURPOSE: To determine if the presence or absence of retinal and choroidal folds on SD-OCT imaging can distinguish between mild papilloedema and pseudopapilledema. DESIGN: Cross-sectional cohort study METHODS: Subjects with optic disc elevation (Frisen grades 1 and 2 only) were eligible to be enrolled prospectively. Pseudopapilledema was defined as a lack of change in optic disc appearance between two visits <6 months apart, and papilloedema was defined as change in optic disc appearance between two visits <6 months apart determined by review of fundus photographs by a masked neuro-ophthalmologist. Three masked neuro-ophthalmologists independently reviewed en face and axial optical coherence tomography (OCT) images of the optic nerve of the study subjects for the presence or absence of retinal and choroidal folds. Concordance was determined when there was agreement between at least 2 of the 3 observers. RESULTS: Forty-five subjects (78 eyes) met inclusion criteria. There were 32 eyes with papilloedema and 46 eyes with pseudopapilledema. Choroidal and/or retinal folds were detected in 38% of eyes (12/32) with papilloedema and 19.6% of eyes (9/46) with pseudopapilledema. Post-hoc analyses eliminated six questionable cases of pseudopapilledema that had ancillary testing suggestive of elevated intracranial pressure and resulted in one remaining eye (2%) with more certain pseudopapilledema that was found to have folds. En face OCT imaging was more sensitive (71%) in detection of folds than axial OCT imaging (57%). CONCLUSIONS: Choroidal and/or retinal folds on OCT are commonly observed in patients with mild papilloedema and are uncommon in those with pseudopapilledema. The presence of folds on OCT in patients presenting with disc elevation suggests papilloedema.
Authors: Leonardo E Ariello; Luiz Guilherme Marchesi Mello; Sérgio Luis Gianotti Pimentel; Mário L R Monteiro Journal: Int J Retina Vitreous Date: 2022-07-22