Optical Coherence Tomography as an Adjunctive Tool for Diagnosing Papilledema in Young Patients

PURPOSE: The authors examined the peripapillary (3.4-mm diameter) retinal nerve fiber layer thickness (RNFL thickness) as depicted by optical coherence tomography (OCT) in young patients with pseudopapilledema or papilledema. METHODS: In 17 consecutive patients (6 to 20 years old) with bilateral newly diagnosed papilledema or pseudopapilledema, the eye with the thicker mean global RNFL per patient was analyzed. Excluded were patients in whom cerebrospinal fluid opening pressure was between 190 and 250 mm H(2)O ("gray zone"). RNFL thickness was compared in eyes with papilledema and pseudopapilledema using the Mann-Whitney U test. RESULTS: Papilledema was clinically diagnosed in 9 patients and pseudopapilledema in 6 patients; 2 patients were excluded. Median RNFL thickness in the eyes with papilledema was greater than that of both eyes with pseudopapilledema and controls at all 12 clock hours. In all 9 patients with papilledema, RNFL was thickened contiguously for 8 to 12 clock hours above the upper 95% confidence interval limit of normal. CONCLUSION: The peripapillary RNFL thickness as depicted by OCT was found to be a reliable adjunctive tool in the differentiation of newly diagnosed papilledema and pseudopapilledema in young patients. Larger cohorts are required to confirm these observations and conclusion.