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Diagnostic performance of conventional optical coherence tomography parameters for differentiating pediatric
Selda Celik Dulger1, Aykut Karatas2
1Department of Ophthalmology, Ankara Etlik City Hospital, Halil Sezai Erkut Caddesi No:5, Yenimahalle, Ankara, Türkiye. drsldclk@gmail.com.
Purpose:
To evaluate the diagnostic performance of conventional optical coherence tomography (OCT)-derived peripapillary retinal nerve fiber layer (RNFL) and macular ganglion cell-inner plexiform layer (GC-IPL) thickness measurements for differentiating papilledema from pseudopapilledema in children.
Methods:
This retrospective study included 115 pediatric patients (230 eyes) with papilledema, optic disc drusen (ODD)-related pseudopapilledema, pseudopapilledema without optic disc drusen, and healthy controls. Peripapillary RNFL and macular GC-IPL thicknesses were measured using spectral-domain OCT. Group comparisons were performed using generalized estimating equations, and diagnostic performance was assessed using receiver operating characteristic analysis.
Results:
The study included 26 patients (52 eyes) with papilledema, 30 patients (60 eyes) with optic disc drusen (ODD)-related pseudopapilledema, 32 patients (64 eyes) with pseudopapilledema without ODD, and 27 healthy controls (HCs) (54 eyes). Mean pRNFL thickness was 129.85 ± 51.08 μm in the papilledema group, 128.22 ± 36.78 μm in the ODD-related pseudopapilledema group, 106.64 ± 17.10 μm in the pseudopapilledema without ODD group, and 99.89 ± 11.29 μm in the healthy control group. Compared with HCs, RNFL thickness was significantly increased in all quadrants in eyes with ODD-related pseudopapilledema, in three quadrants in papilledema, and only in the superior quadrant in pseudopapilledema without ODD. Compared with HCs, inferior RNFL demonstrated the highest discriminatory ability for papilledema (AUC = 0.848, p < 0.001) and ODD-related pseudopapilledema (AUC = 0.906, p < 0.001), whereas superior RNFL showed significant discrimination for pseudopapilledema without ODD (AUC = 0.720, p = 0.001). For differentiating papilledema from ODD-related pseudopapilledema, nasal RNFL yielded the highest AUC among the evaluated RNFL parameters (AUC = 0.699, p = 0.005). For papilledema versus pseudopapilledema without ODD, inferior RNFL demonstrated the highest diagnostic performance (AUC = 0.732, p < 0.001), followed by temporal RNFL (AUC = 0.710, p = 0.002). Several GC-IPL parameters demonstrated significant discriminatory ability in specific comparisons, with inferonasal GC-IPL showing the highest AUC for ODD-related pseudopapilledema versus healthy controls (AUC = 0.731, p = 0.004) and superotemporal GC-IPL showing the highest AUC for papilledema versus ODD-related pseudopapilledema (AUC = 0.769, p = 0.001).
Conclusions:
Conventional OCT-derived RNFL measurements demonstrated limited diagnostic performance for distinguishing pediatric papilledema from pseudopapilledema, particularly in eyes with ODD-related pseudopapilledema. OCT findings should therefore be interpreted together with clinical assessment and, where available, advanced optic nerve head imaging techniques.
