Diagnostic Ability of Transverse Axial Images Obtained by Optical Coherence Tomography for Detecting Anterior Displacement of Peripapillary Tissues in Papilledema.

Abstract

Background: To evaluate the diagnostic ability of optical coherence tomography (OCT) images to detect posterior pole deformation and anterior displacement of the optic disc (ADOD) in papilledema before and after intracranial pressure reduction with medical treatment. Additionally, we compared the analysis of these images with peripapillary retinal nerve fibre layer (pRNFL) thickness measurements in detecting papilledema.

Methods: In this retrospective, observational, descriptive, and comparative study, participants underwent swept-source OCT with high-resolution imaging. Papilledema cases were analysed at baseline and 7-30 days post-treatment. Two masked examiners independently assessed images for ADOD.

Results: The study included 82 eyes from 41 patients, with 50 eyes having papilledema and 32 eyes with optic disc drusen (ODD) as controls. At baseline, ADOD was observed in 50% of papilledema eyes and 32% post-treatment. A reduction in ADOD was noted in 34% of papilledema eyes. Cohen's κ coefficient indicated substantial agreement (0.799). Mean pRNFL thickness significantly decreased from baseline to post-treatment (305.4 ± 140.2 vs. 245.3 ± 94.5 μm, p < 0.001). Logistic regression demonstrated an association between mean pRNFL thickness and ADOD at baseline (OR = 1.016, p = 0.001) and post-treatment (OR = 1.012, p = 0.004).

Conclusion: OCT B-scan analysis is an effective tool for detecting ADOD and posterior pole deformation in papilledema and distinguishing it from ODD. ADOD correlates with the severity of optic disc oedema and may serve as a more sensitive or specific indicator of treatment response compared to pRNFL thickness. These findings highlight the value of OCT axial imaging in diagnosing and monitoring papilledema, offering clinicians a reliable method for assessing disease progression and treatment efficacy.