Título

DIAGNOSTIC ABILITY OF AXIAL IMAGES OBTAINED BY OCT IN PAPILLEDEMA SECONDARY TO IDIOPATHIC INTRACRANIAL HYPERTENSION

Objetivo

To evaluate the diagnostic ability of axial images obtained by OCT in demonstrating anterior displacement of the optic disc (ADOD) secondary to papilledema due to IIH. We also compared the diagnostic ability of axial images and measurements of RNFL thickness before and after initiation of treatment.

Método

A retrospective, comparative study was conducted on participants diagnosed with papilledema secondary to IIH. For controls, participants diagnosed with optic disc drusen (ODD). 81 eyes from 41 patients were included, 24 having papilledema and 17 with ODD. In participants with papilledema, images were analyzed before and 7-14 days after treatment initiation. Two independent and masked examiners for diagnosis analyzed the axial images of participants with papilledema and ODD. The examiners were asked to indicate the presence of ADOD and peripapillary tissues, and whether there was a change in the second image acquired after treatment.

Resultado

The ADOD was present in almost 50% of the papilledema eyes at baseline (21;23), and in almost 30% post-treatment (14;14). A decrease in the ADOD between images was noted in 13 cases (26,5%) for both observers. The reproducibility and consistency of the method were good. The mean RNFL thickness of the papilledema group decreased significantly comparing baseline measurement to the post-treatment (291.37 ± 154.80 compared to 228.02 ± 106.41, p=0.0001). The mean RNFL thickness at the baseline was associated with ADOD (OR = 1.011797, p= 0.0001), and at post-treatment was also associated with ADOD (OR = 1.019777, p= 0.0001).

Conclusão

OCT examination is a useful diagnostic tool in differentiating participants with papilledema from those with ODD. The analysis of axial OCT images can demonstrate improvement in deformation and ADOD caused by IIH, detecting improvement with treatment. Post-treatment ADOD may serve as an additional biomarker of papilledema improvement. The greater the mean RNFL thickness, the greater the optic disc edema and the more likely anterior displacement will be present.