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Clara Afonso, Ali Raza, Danilo Fernandes, Donald Hood, Mario Monteiro; Evaluation of Inner Retinal Thicknesses in the Macula of Patients with Chronic Papilledema from Pseudotumor Cerebri Syndrome Using Frequency Domain OCT. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4368. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the thickness of inner retinal layers in the macula using frequency domain optical coherence tomography (fdOCT) in patients with chronic papilledema from pseudotumor cerebri syndrome (CPfPCS) with a view towards detection and the correlation with visual field loss on standard automated perimetry (SAP).
A total of 55 eyes from 29 CPfPCS patients and 65 eyes from 34 healthy controls were tested with fdOCT (3DOCT-1000; Topcon, Inc.) and SAP (24-2, HFA; CZM, Inc.). The individual layers from macular fdOCT cube scans (128 Bscans) were segmented using a previously validated automated algorithm,  which was then manually hand-corrected . For each scan, we determined the thickness of the retinal nerve fiber layer (RNFL), the combined retinal ganglion cell plus inner plexiform layers (RGCL+), the inner nuclear layer (INL), and the total retina (TR). The visual field was analyzed based on mean deviation (MD) and the linear (1/Lambert) sensitivity of the 12 central points, approximately covering the ±10° region of the scan. Generalized estimating equation models, accounting for age and inter-eye correlations, were used to determine statistical significance. Correlations between measurements were verified using either Pearson’s (VF loss in 1/Lambert units) or Spearman’s (MD) correlation coefficients.
In eyes with CPfPCS, macular thickness parameters (mean ± SD) corresponding to the RNFL, RGCL+, INL and TR were: 29.1 ± 9.9; 61.4 ± 9.1; 32.0 ± 2.3 and 258.3 ± 19.0 µm, respectively. Corresponding values from control eyes were: 38.4 ± 4.3; 70.0 ± 5.5; 31.3 ± 2.5 and 271.4 ± 13.4 µm. The macular RNFL, RGCL+, and TR thickness measurements were significantly thinner in eyes with CPfPCS than controls (p<0.001). The INL thickness measurements were not significantly different between groups (p=0.08). RNFL, RGCL+ and TR measurements were correlated with VF sensitivity loss assessed with SAP (r=0.45 to 0.69).
Eyes with chronic papilledema show significant thinning of the macular RGCL and RNFL. The degree of thinning is associated with the severity of visual field damage in these eyes. Macular thickness measurements could potentially be used to evaluate the degree of ganglion cell loss in patients with papilledema from pseudotumor cerebri syndrome. 1. Yang et al (2010), Opt. Exp; 2. Raza et al (2011) Archives.
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