Evaluation of Role of Optical Coherence Tomography in Diagnosis of Papilledema and Pseudopapilledema

Abstract

Background: Papilledema is a swelling of the optic nerve head, while pseudopapilledema include
hyperopia and congenital disc elevations. Optical coherence tomography (OCT) is an imaging tool that
provides histologic information on neural tissue. The aim of the present study was to assess the early
and non- invasive diagnosis of papilledema and differentiating it from pseudopapilledema using optical
coherence tomography (OCT). Patients and methods: this study included adult patients above 18
years old presented to the outpatient clinic of Zagazig University Hospital, diagnosed clinically to have
swollen disc by funds biomicoscopy. The Eyes ( n=45) had been stratified into 3 groups: Group (1)
with 15 normal eyes, Group (2) with 15 eyes with papilledema and Group (3) with 15 eyes with
pseudopapilledema (e.g. optic disc drusen and narrow disc due to hypermetropia). Results: There is
statistically significant difference between the studied groups regarding horizontal elevation. There is
statistically significant difference between the studied groups regarding vertical elevation. On LSD
comparison, the difference is significant between papilledema and each other group. The highest value
occurs in papilledema group followed by pseudo papilledema group then control group. The best cutoff
of inferior RNFL in diagnosis of pseudo papilledema is ≥135.5 with area under curve 0.987, sensitivity
93.3%, specificity 86.7%, positive predictive value 87.5%, negative predictive value 92.9%, accuracy
90%. The best cutoff of superior RNFL in diagnosis of pseudo papilledema is ≥132.5 with area under
curve 0.916, sensitivity 86.7%, specificity 73.3%, positive predictive value 76.5%, negative predictive
value 86.4%, accuracy 80%. The best cutoff of nasal RNFL in diagnosis of pseudo papilledema is ≥78
with area under curve 0.918, sensitivity 86.7%, specificity 73.3%, positive predictive value 76.5%,
negative predictive value 86.4%, accuracy 80%. Conclusion: Using OCT can provide a valuable
measures for differentiating papilledema from pseudopapilledema