Retinal and Choroidal Folds in Papilledema.
OBJECTIVE
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.).
Department of Ophthalmology State University of New York at Stony Brook, Stony Brook, New York, United States.
Patrick A
PA
Sibony
Hyman-Newman Institute for Neurosurgery, Roosevelt Hospital, New York, New York, United States; and the New York Eye and Ear Infirmary, New York, New York, United States.
Mark J
MJ
Kupersmith
Department of Ophthalmology, Flaum Eye Institute, University of Rochester School of Medicine & Dentistry, Rochester, New York, United States.
Steven E
SE
Feldon
Department of Electrical and Computer Engineering, University of Iowa, Iowa City, Iowa, United States; and Iowa City VA Health Care System, Iowa City, Iowa, United States.
Jui-Kai
JK
Wang
Department of Electrical and Computer Engineering, University of Iowa, Iowa City, Iowa, United States; and Iowa City VA Health Care System, Iowa City, Iowa, United States.
Mona
M
Garvin
D000328:Adult; D000368:Aged; D001696:Biomechanical Phenomena; D002829:Choroid / Q000473:pathology*; D005260:Female; D006801:Humans; D019586:Intracranial Hypertension / Q000175:diagnosis; D007427:Intracranial Pressure / Q000502:physiology; D007429:Intraocular Pressure / Q000502:physiology; D008297:Male; D008875:Middle Aged; D009412:Nerve Fibers / Q000473:pathology; D009898:Optic Disk / Q000473:pathology; D010211:Papilledema / Q000175:diagnosis* / Q000503:physiopathology; D012030:Refractive Errors / Q000503:physiopathology; D012160:Retina / Q000473:pathology*; D041623:Tomography, Optical Coherence / Q000379:methods; D014792:Visual Acuity / Q000502:physiology