title: Optical coherence tomography in papilledema and pseudopapilledema with and without optic nerve head drusen.
abstract: OBJECTIVE
  To compare the spectral domain optical coherence tomography (SD-OCT) findings of the optic disc and the peripapillary retina of patients with a true papilledema and pseudopapilledema with and without optic nerve head drusen (ONHD).
  
  
  METHODS
  Retrospective Case Control Study.
  
  
  METHODS
  Peripapillary retinal nerve fiber layer (PPRNFL) thickness as depicted by SD-OCT of 94 eyes of 66 patients with papilledema (30 eyes), pseudopapiledema (31 eyes), and normal controls (33 eyes) was analyzed. The mean RNFL thickness, total retinal thickness (TRT) at a superior and inferior edge of the disc and the quadrant wise topography of increased RNFL were compared in all three groups. Sensitivity, specificity, and area under the receiver operating characteristic curve (AROC) were calculated for all the parameters.
  
  
  RESULTS
  The median RNFL thickness was 185.4 (129.5-349.3 μm), 122.3 (109-156.3 μm) and 91.62 ± 7 μm in papilledema, pseudopapilledema, and controls, respectively. Papilledema group had thicker PPRNFL in all quadrants except temporal quadrant. TRT was thicker in papilledema and pseudopapilledema compared to controls. ONHD could be directly visualized as high reflective clumps in the sub-retinal space or the RNFL in 30 eyes. Increased RNFL thickness in all four quadrants was noted 43.3% in papilledema and 9.7% in pseudopapilledema. Normal RNFL thickness in all four quadrants was noted in 0% in papilledema and 32.3% in pseudopapilledema. Nasal RNFL had the highest AROC (0.792) indicating high diagnostic ability to differentiate papilledema from pseudopapilledema.
  
  
  CONCLUSIONS
  SD-OCT can be used as a tool to differentiate between papilledema and pseudopapilledema.
authors.affiliation: Department of Neuro Ophthalmology, Sankara Nethralaya, A Unit of Medical Research Foundation, Nungambakkam, Chennai, Tamil Nadu, India.
authors.forename: Shikha Talwar
authors.initials: ST
authors.lastname: Bassi
authors.forename: Kuppuswamy Parthasarthy
authors.initials: KP
authors.lastname: Mohana
mesh_terms: D000328:Adult; D015785:Eye Diseases, Hereditary / Q000175:diagnosis*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009898:Optic Disk / Q000473:pathology*; D015594:Optic Disk Drusen; D009901:Optic Nerve Diseases / Q000175:diagnosis*; D010211:Papilledema / Q000175:diagnosis*; D012372:ROC Curve; D012165:Retinal Ganglion Cells; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence / Q000379:methods*; D014792:Visual Acuity; D014794:Visual Fields