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. 2014 Dec;62(12):1146-51.
doi: 10.4103/0301-4738.149136.

Optical coherence tomography in papilledema and pseudopapilledema with and without optic nerve head drusen

Shikha Talwar Bassi  1 , Kuppuswamy Parthasarthy Mohana
Affiliations

Optical coherence tomography in papilledema and pseudopapilledema with and without optic nerve head drusen

Shikha Talwar Bassi et al. Indian J Ophthalmol. 2014 Dec.

Abstract

Aim: To compare the spectral domain optical coherence tomography (SD-OCT) findings of the optic disc and the peripapillary retina of patients with a true papilledema and pseudopapilledema with and without optic nerve head drusen (ONHD).

Study design: Retrospective Case Control Study.

Subjects and methods: Peripapillary retinal nerve fiber layer (PPRNFL) thickness as depicted by SD-OCT of 94 eyes of 66 patients with papilledema (30 eyes), pseudopapiledema (31 eyes), and normal controls (33 eyes) was analyzed. The mean RNFL thickness, total retinal thickness (TRT) at a superior and inferior edge of the disc and the quadrant wise topography of increased RNFL were compared in all three groups. Sensitivity, specificity, and area under the receiver operating characteristic curve (AROC) were calculated for all the parameters.

Results: The median RNFL thickness was 185.4 (129.5-349.3 μm), 122.3 (109-156.3 μm) and 91.62 ± 7 μm in papilledema, pseudopapilledema, and controls, respectively. Papilledema group had thicker PPRNFL in all quadrants except temporal quadrant. TRT was thicker in papilledema and pseudopapilledema compared to controls. ONHD could be directly visualized as high reflective clumps in the sub-retinal space or the RNFL in 30 eyes. Increased RNFL thickness in all four quadrants was noted 43.3% in papilledema and 9.7% in pseudopapilledema. Normal RNFL thickness in all four quadrants was noted in 0% in papilledema and 32.3% in pseudopapilledema. Nasal RNFL had the highest AROC (0.792) indicating high diagnostic ability to differentiate papilledema from pseudopapilledema.

Conclusion: SD-OCT can be used as a tool to differentiate between papilledema and pseudopapilledema.

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Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
The triangular subretinal hyporeflective space in papilledema (a, b) and the buried optic nerve head drusen in pseudopapilledema (c, d)
Figure 2
Figure 2
Buried optic nerve head drusen seen as a round hyperreflective echo (red arrow) above the retinal pigment epithelium
Figure 3
Figure 3
Pre- (a) and post-treatment (b) retinal nerve fiber layer in papilledema
Figure 4
Figure 4
In resolving papilledema at the level of the watermark sign a discrete hyperreflective echo seen above the retinal pigment epithelium
See this image and copyright information in PMC

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Supplementary concepts