Re-evaluating diabetic papillopathy using optical coherence tomography and inner retinal sublayer analysis.

Area of Science:

• Ophthalmology
• Neuro-ophthalmology
• Medical Imaging

Background:

• Diabetic papillopathy and non-arteritic anterior ischemic optic neuropathy (NAION) can present with optic disc swelling in diabetic patients.
• Distinguishing between these conditions is crucial for appropriate management and prognosis.
• Optical coherence tomography (OCT) offers quantitative analysis of retinal layers.

Purpose of the Study:

• To re-evaluate diabetic papillopathy using OCT for quantitative analysis of peripapillary retinal nerve fibre layer (pRNFL), macular ganglion cell layer (mGCL), and inner nuclear layer (mINL) thickness.
• To assess potential diagnostic distinctions between diabetic papillopathy and NAION using OCT.
• To investigate the prognostic relevance of retinal layer atrophy for visual acuity.

Main Methods:

• Retrospective observational case series of 24 eyes from 22 patients with diabetes and optic disc swelling.
• Patients diagnosed with NAION or diabetic papillopathy via neuro-ophthalmological assessment.
• OCT analysis of pRNFL, mGCL, and mINL thicknesses performed after resolution of optic disc swelling.

Main Results:

• Significant thinning of pRNFL and mGCL was observed in both diabetic papillopathy and NAION groups post-swelling.
• The mINL volume remained unchanged, showing no thinning.
• A strong correlation was found between reduced mGCL thickness and poorer visual acuity (ETDRS letters).

Conclusions:

• Post-resolution of optic disc swelling, atrophy of pRNFL and mGCL is evident in both diabetic papillopathy and NAION.
• OCT analysis did not provide a clear diagnostic distinction between diabetic papillopathy and NAION.
• The degree of pRNFL and mGCL atrophy appears to have prognostic relevance for visual acuity outcomes, irrespective of the specific diagnosis.