Optical Coherence Tomography Angiography in Papilledema Compared With Pseudopapilledema

Abstract

PurposeThe purpose of this study is to evaluate differences in optical coherence tomography angiography (OCT-A) findings between patients with papilledema and pseudopapilledema.MethodsIn this prospective, comparative study, 41 eyes of 21 subjects with papilledema, 27 eyes of 15 subjects with pseudopapilledema, and 44 eyes of 44 healthy normal subjects were included and were imaged using OCT-A. In addition to peripapillary total vasculature maps obtained with commercial vessel density mapping, major vessel removal using customized image analysis software was also used to measure whole image capillary density and peripapillary capillary density (PCD). Peripapiilary retinal nerve fiber layer (RNFL) and macular ganglion cell complex (GCC) were recorded.ResultsAverage RNFL thicknesses were greater in papilledema eyes than in pseudopapilledema and control subjects. GCC thickness was not different among three groups. Peripapillary vasculature values were significantly lower in papilledema (58.5 ± 6.1%) and pseudopapilledema (58.9 ± 4.7%) eyes compared with healthy eyes (63.2 ± 3.1%) using commercial machine software, without a difference between papilledema and pseudopapilledema eyes. However, using our customized software, peripapillary “capillary” density of papilledema eyes was 29.8 ± 9.4%, which was not significantly different from healthy subjects (31.8 ± 7.4%; P = 0.94). Pseudopapilledema eyes with peripapillary density of 25.5 ± 8.3% had significantly lower capillary values compared with control eyes (P = 0.01). There was a significantly lower whole image and nasal sector peripapillary capillary density of inner retina in pseudopapilledema eyes than papilledema eyes (P = 0.03 and P = 0.02, respectively).ConclusionsWhole image and nasal peripapillary sector capillary densities using OCT-A had diagnostic accuracy for differentiating true and pseudo-disc swelling.

<p>Optical Coherence Tomography Angiography in Neurodegenerative Diseases: A Review</p>

“…26 Furthermore, Fard et al demonstrated that OCT-A in papilloedema demonstrated increased whole image density and nasal peripapillary density compared to discs with pseudopapilloedema. 59 This was particularly obvious in papilloedema grades 1 and 2. 59 In grade 3 or 4 papilloedema, the peripapillary capillary density was reduced and was not very useful to differentiate between grade 3 or 4 papilloedema from pseudo-papilloedema.…”

Evaluation of retinal microvascular perfusion in hereditary angioedema: a case-control study

“…Summarizing our findings, in HAE patients, we might assume that a subclinical edema formation increases the thickness of the parafoveal area and leads to a "relative" reduction of the vascular network by compressing the existing capillaries [27,28]. The significant reduction in vessel density values that was detected in HAE cohort looks like the low vessel density documented in patients with papilledema and pseudopapilledema in whom hypothetically the apparent reduced density of vessels on OCT-A might be due to slow flow resulting from compression/stasis [28,29]. In this view, in C1INH deficiency-HAE the endothelial barrier failure with enhanced vascular permeability can likely involve tissues and organs at the site of attacks [3].…”

“…Further investigations including a larger HAE cohort might lead to an improvement of the analysis by comparing among subgroups of patients (e.g., between patients currently taking androgens and having ever taken androgens, as well as patients experiencing treated vs. untreated attacks). In addition, future studies on structural analysis of the retina are certainly awaited [29,31].…”

Optical Coherence Tomography Angiography to Detect and Differentiate Ischemic Optic Neuropathy from Papilledema - Systematic Review

“…and two studies were related to the optic disc edema. [19,20] All of them are small sampled size (~6-41 eyes) or (~ 5-30 patients) in NA-AION and (˜25-44 eyes) or (˜12-22 patients) in papilledema, and some of them are retrospective and without a control group. Mean age, time of diagnosis (acute ou non-acute), and gender had wide variability.…”

“…(2) possible dropout in the chronic stages or very severe edema causing compression or undetectable by the sluggish flow; (3) RNFL average and sectoral thickness are greater than control or other pseudopapilledemas. [10,19,20]…”