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Mark J Kupersmith, Patrick A Sibony, Steven E Feldon, Jui-Kai Wang, Mona K Garvin, Randy H Kardon; The Effect of Treatment of Idiopathic Intracranial Hypertension on Prevalence of Retinal and Choroidal Folds. Invest. Ophthalmol. Vis. Sci. 201657(12):.
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© ARVO (1962-2015); The Authors (2016-present)
Using spectral domain optical coherence tomography (SDOCT), we described three types of folds in the retina associated with papilledema in untreated patients with mild vision loss at enrollment into the Idiopathic Intracranial Hypertension Treatment Trial (IIHTT). We report the change in these folds and relationship to treatment and IIH features over six months.
We evaluated study eyes (87/125) from participants in the OCT Substudy of the IIH treatment trial, who were randomly assigned to acetazolamide (ACZ, n=44) or placebo (PLB, n=43) treatment and had reliable SDOCT images of the optic disc and macula regions at baseline, at 3 and 6 months. For each date the presence, resolution or new onset of peripapillary wrinkles (PPW) (1B), retinal folds (RF) (1A,2A), choroidal folds (CF), and any type of fold affecting the macula (3A), using transaxial and en face views was noted. The prevalence of each type of fold was related to treatment and to the measurement or change in Bruch’s membrane deformation at the optic nerve head, retinal nerve fiber layer (RNFL) thickness, ONH volume, Frisén papilledema grade, and cerebrospinal fluid (CSF) pressure.
At presentation, except for an increase of PPW in ACZ eyes (64% vs 28%), both treatment groups were matched for all OCT features. At six months compared with baseline, ACZ-treated, but not PLB-treated, eyes had fewer folds of all types (p < 0.01), with greatest reduction (57%) in RF. Only PPW were newly detected as the papilledema improved (1B,2B). Resolution of RF (1B) and folds in the macula (3B), but not of PPW and CF, was associated with significant reduction in RNFL thickness, ONH volume and Frisén grade. Change in Bruch’s membrane deformation or CSF pressure did not correlate with a change in any type of fold. PPW (10), RF (7), CF (3) were seen even in the 27 eyes with a papilledema grade 0 or 1.
Changes in retinal and choroidal folds associated with papilledema reflect ACZ treatment effect, Persistence of these folds despite marked improvement in disc edema, suggests permanent changes in the affected retinal tissues or persistence of biomechanical forces at the optic nerve head, in spite of decreased papilledema.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
Each number is for one eye at baseline (A) and 6 mos. (B). Arrows point to folds. RF in 1A are numerous, inferior and temporal to disc.
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