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2015 ; 56
(10
): 5670-80
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Retinal and Choroidal Folds in Papilledema
#MMPMID26335066
Sibony PA
; Kupersmith MJ
; Feldon SE
; Wang JK
; Garvin M
Invest Ophthalmol Vis Sci
2015[Sep]; 56
(10
): 5670-80
PMID26335066
show ga
PURPOSE: To determine the frequency, patterns, associations, and biomechanical
implications of retinal and choroidal folds in papilledema due to idiopathic
intracranial hypertension (IIH). METHODS: Retinal and choroidal folds were
studied in patients enrolled in the IIH Treatment Trial using fundus photography
(n = 165 study eyes) and spectral-domain optical coherence tomography (SD-OCT; n
= 125). We examined the association between folds and peripapillary shape,
retinal nerve fiber layer (RNFL) thickness, disc volume, Frisén grade, acuity,
perimetric mean deviation, intraocular pressure, intracranial pressure, and
refractive error. RESULTS: We identified three types of folds in IIH patients
with papilledema: peripapillary wrinkles (PPW), retinal folds (RF), and choroidal
folds (CF). Frequency, with photos, was 26%, 19%, and 1%, respectively; SD-OCT
frequency was 46%, 47%, and 10%. At least one type of fold was present in 41% of
patients with photos and 73% with SD-OCT. Spectral-domain OCT was more sensitive.
Structural parameters related to the severity of papilledema were associated with
PPW and RF, whereas anterior deformation of the peripapillary RPE/basement
membrane layer was associated with CF and RF. Folds were not associated with
vision loss at baseline. CONCLUSIONS: Folds in papilledema are biomechanical
signs of stress/strain on the optic nerve head and load-bearing structures
induced by intracranial hypertension. Folds are best imaged with SD-OCT. The
patterns of retinal and choroidal folds are the products of a complex interplay
between the degree of papilledema and anterior deformation of the load-bearing
structures (sclera and possibly the lamina cribrosa), both modulated by
structural geometry and material properties of the optic nerve head.
(ClinicalTrials.gov number, NCT01003639.).
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