Optical Coherence Tomography Angiography in Papilledema Compared With Pseudopapilledema

Area of Science:

• Ophthalmology
• Medical Imaging
• Neuro-ophthalmology

Background:

• Papilledema and pseudopapilledema present as optic disc swelling, necessitating accurate differentiation for appropriate patient management.
• Optical coherence tomography angiography (OCT-A) offers a non-invasive method to visualize optic nerve head vasculature.

Purpose of the Study:

• To evaluate the diagnostic capability of OCT-A in distinguishing between papilledema and pseudopapilledema.
• To compare OCT-A findings, including vessel density and capillary density, in patients with papilledema, pseudopapilledema, and healthy controls.

Main Methods:

• A prospective, comparative study involving 21 patients with papilledema, 15 with pseudopapilledema, and 44 healthy controls.
• OCT-A imaging was performed, analyzing peripapillary vasculature using both commercial vessel density mapping and customized software for capillary density measurements.
• Retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) thickness were also assessed.

Main Results:

• Commercial OCT-A software showed no significant difference in peripapillary vasculature between papilledema and pseudopapilledema groups compared to controls.
• Customized software revealed significantly lower peripapillary capillary density in pseudopapilledema compared to healthy eyes.
• Whole image and nasal sector peripapillary capillary densities were significantly lower in pseudopapilledema than in papilledema eyes.

Conclusions:

• Customized OCT-A analysis of whole image and nasal peripapillary sector capillary densities demonstrates diagnostic accuracy in differentiating true disc swelling (papilledema) from pseudo-disc swelling (pseudopapilledema).
• These findings highlight the potential of advanced OCT-A image analysis for improved clinical diagnosis in neuro-ophthalmology.