Multicolor imaging in optic disc swelling

Abstract

Differentiating optic disc edema (ODE) from pseudo optic disc edema (PODE) continues to pose a diagnostic dilemma. Current report highlights the role of multicolor imaging (MC) in differentiating ODE from PODE. Composite multicolor images of the disc in ODE show greenish hyperreflectance that extends beyond the optic disc margins with irregular blurry margins and obscured disc vasculature whereas PODE shows a greenish hyperreflectance with clear and distinct margins and well delineated disc vasculature. MC imaging adds to the present armamentarium of imaging modalities obviating needless neurological evaluation mandatory in a case of true disc edema.

Figure 1

Fundus photograph showing disc elevation with blurring of margins and preserved vascular pattern in the right and left eye; suggestive of optic nerve head drusen (a and b). Ultrasonography B-scan showing high reflective clump echo (arrow) noted on the optic nerve head persisting in low gain in both eyes (c and d)

Figure 2

MC, IR, GR, and BR images of the right (a-d) and left (e-h) eyes with optic nerve head drusen. MC images show a greenish hyperreflective ring with clear, discrete margins and well-delineated disc and retinal vasculature. Vasculature noted to be best seen on IR images. MC, IR, BR, and GR images of a normal individual (i-l). MC: Multicolor, IR: Infrared reflectance, GR: Green reflectance, BR: Blue reflectance

Figure 3

Fundus photograph of the right eye in a case of nonarteritic anterior ischemic optic neuropathy showing disc edema with pronounced inferotemporal sectoral edema and splinter hemorrhages (a). Fundus photographs of the right and left eyes showing gross disc edema and disc hemorrhages with macular edema in the left eye (b and c)

Figure 4

MC, IR, BR, and GR images of the right eye in a case of nonarteritic anterior ischemic optic neuropathy (a-d) and of the right (e-h) and left (i-l) eyes in a case of bilateral disc edema. MC images show a greenish hyperreflective ring with blurry irregular margins and obscured disc and peripapillary retinal vasculature. Image i shows extension of the greenish hue temporally involving the macula. Vasculature noted to be best seen on IR images. MC: Multicolor, IR: Infrared reflectance, GR: Green reflectance, BR: Blue reflectance

Figure 5

Multicolor and spectral domain optical coherence tomography peripapillary retinal nerve fiber layer images in a case of optic nerve head drusen showing well-defined, discrete margins (white arrowheads) with the absence of involvement of the peripapillary retinal nerve fiber layer (a). Multicolor and spectral domain optical coherence tomography images in cases of true disc edema showing irregular blurry margins (white arrowheads) with involvement of the peripapillary retinal nerve fiber layer (b and c). Spectral domain optical coherence tomography image (c) also shows macular edema with neurosensory detachment

Figure 6

Multicolor and spectral domain optical coherence tomography images of the optic nerve head. Uniform green intensity noted in global disc edema (a) while multicolor images (b and c) show increased intensity (red arrows) at points of maximal edema and elevation (white arrows), respectively