Retinal and Choroidal Folds in Papilledema

Abstract

Folds in papilledema are biomechanical signs of stress/strain on the optic nerve head and load-bearing structures induced by intracranial hypertension. Folds are best imaged with SD-OCT. The patterns of retinal and choroidal folds are the products of a complex interplay between the degree of papilledema and anterior deformation of the load-bearing structures (sclera and possibly the lamina cribrosa), both modulated by structural geometry and material properties of the optic nerve head. (ClinicalTrials.gov number, NCT01003639.).

Optic disc haemorrhages at baseline as a risk factor for poor outcome in the Idiopathic Intracranial Hypertension Treatment Trial

“…Other than peripapillary wrinkles,3 retinal folds3 and retinal nerve fibre layer haemorrhages, other ancillary funduscopic findings in the papilloedema of IIH are uncommon. Subretinal haemorrhages4–6 and pseudodrusen have been the subject of a few case reports7 8 Cotton wool spots have been documented in association with papilloedema and anaemia with two of the five cases having these nerve fibre layer infarcts 9…”

“Paton's Folds” Revisited: Peripapillary Wrinkles, Folds, and Creases in Papilledema

“…5 The most frequent types of folds were peripapillary wrinkles (PPW, 46%), retinal folds (47%) and choroidal folds (10%). We observed ORF on the OCT, but they were difficult to image because the overlying edema shadowed the peripapillary retina.…”

“…Our case prompted us to re-examine the IHTT-OCT sub-study 5 data for ORF and creases. We identified ORF or creases in 25/125(20%) of the study eyes at baseline, 9% at three months and 4% at six months.…”

“…What seemed to be an “obvious” clinical-pathologic correlation at the time, now with OCT imaging shows that papilledema is associated with several distinctive types of folds i.e. PPW, inner retinal folds, choroidal folds 5 and ORF/creases. Folds and wrinkles of papilledema are structural manifestations of stress and strain induced by the intracranial pressure on the optic nerve head and load bearing structures (sclera, lamina cribrosa) .…”

“…The development of a specific type fold in each case is the product of a complex interaction between structural geometry, tissue material properties and loading force conditions. 5 …”