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Kim Jiramongkolchai, Tariq Bhatti, inas Aboobakar, Carl-Joe Mehanna, Mays El-Dairi; Longitudinal Follow-Up of Papilledema by Optical Coherence Tomography Macular Segmentation. Invest. Ophthalmol. Vis. Sci. 2016;57(12):4220.
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© ARVO (1962-2015); The Authors (2016-present)
Optical coherence tomography (OCT) peripapillary retinal nerve fiber layer (pRNFL) and macular segmentation can assess in vivo retinal neuronal structures. We performed a retrospective, observational clinical study to use OCT segmentation to try to decipher resolution of edema from superimposed atrophy.
Serial Spectralis (Heidelberg, Germany) OCT scans from eyes with high grade papilledema (Frisén grade≥3) due to idiopathic intracranial hypertension (IIH) subsequently treated medically were reviewed. Patients without OCT performed at baseline prior to initiation of treatment or who were unable to undergo OCT were excluded. Spectralis review software was used to obtain pRNFL and segmented macular scans on presentation and longitudinally. Macular segmentation and pRNFL were corrected for plotting errors manually.
A total of 16 eyes of 16 patients were included. Resolving papilledema with medical treatment was accompanied by decreased pRNFL (baseline=273.4±18.4, final=113.1±21.5 µm, p=0.0001), macular NFL (Baseline 1.4±0.07, final 0.9±0.09 mm3, p=0.008), ganglion cell (GCL, baseline=1.1±0.04, final=0.97±0.04 mm3 , p=0.048), inner plexiform layers ( baseline 0.96±0.02 final=0.83±0.03 mm3, p=0.0036), and inner retinal volume (RNFL+GCL+IPL+INL) (baseline=7.2±0.1, final 6.2±0.1 mm3, p<0.0001). Outer retinal layers did not change with time. Peripapillary RNFL thinning was seen by day 7, while GCL thinning was seen by day 28. All patients included had improvement in their visual function (visual acuity and/or visual fields).
Ganglion cell layer thinning, indicative of optic atrophy, lags behind pRNFL thinning, indicative of resolved papilledema. Further prospective studies with larger sample size are warranted to validate the use of this method to monitor response to treatment.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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