Retinal and choroidal folds in papilledema

OCT Substudy Group for the NORDIC Idiopathic Intracranial Hypertension Treatment Trial

Research output: Contribution to journalArticle

36 Scopus citations

Abstract

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.)

Original languageEnglish (US)
Pages (from-to)5670-5680
Number of pages11
JournalInvestigative Ophthalmology and Visual Science
Volume56
Issue number10
DOIs
StatePublished - 2015

Keywords

  • Chorioretinal folds
  • Choroidal folds
  • Idiopathic intracranial hypertension
  • Optic nerve
  • Optical coherence tomography
  • Papilledema
  • Peripapillary folds
  • Retinal folds

ASJC Scopus subject areas

  • Ophthalmology
  • Sensory Systems
  • Cellular and Molecular Neuroscience

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    OCT Substudy Group for the NORDIC Idiopathic Intracranial Hypertension Treatment Trial (2015). Retinal and choroidal folds in papilledema. Investigative Ophthalmology and Visual Science, 56(10), 5670-5680. https://doi.org/10.1167/iovs.15-17459