OCT Based Interpretation of the Optic Nerve Head Anatomy and Prevalence of Optic Disc Drusen in Patients with Idiopathic Intracranial Hypertension (IIH)

Abstract

We aimed to systematically examine the optic nerve head anatomy in patients with idiopathic intracranial hypertension (IIH) using a standardized optical coherence tomography (OCT) protocol. The study retrospectively included 32 patients diagnosed from 2014 to 2021 with IIH. Using OCT, in accordance with a standardized scanning protocol for patients with optic disc drusen, the presence of optic disc drusen, prelaminar hyperreflective lines, peripapillary hyperreflective ovoid mass-like structures, the retinal nerve fiber layer thickness, and macular ganglion cell layer volume was obtained. Optic disc drusen were found in 3.1%, hyperreflective lines in 31.3%, and peripapillary hyperreflective ovoid mass-like structures in 81.3% of all IIH patients at least three months after the time of diagnosis. We found no significant differences in retinal nerve fiber layer thickness or macular ganglion cell layer volume in patients with hyperreflective lines or PHOMS respectively compared to patients without hyperreflective lines (p = 0.1285 and p = 0.1835). In conclusion, the prevalence of optic disc drusen in IIH patients is similar to the reported prevalence in the general population. The high prevalence of hyperreflective lines and peripapillary hyperreflective ovoid mass-like structures in IIH patients suggest these structures be a result of crowding in the optic nerve head caused by papilledema.

Clinical and Multi-Mode Imaging Features of Eyes With Peripapillary Hyperreflective Ovoid Mass-Like Structures

“…During our follow-up, we found that PHOMS did not disappear. These findings are roughly the same as what has been previously reported in the literature ( 8 , 9 , 11 , 17 ).…”

“…Optic disc edema is caused by increased intracranial pressure or optic neuritis, and can be a serious threat to vision and life ( 3 , 23 ). PHOMS may be caused by some degree of optic disc congestion or axonal stasis ( 17 ). Under certain circumstances, it is necessary to examine the patient's intracranial pressure at the time of initial diagnosis, and to examine the cause of intracranial pressure, using methods such as neuroimaging and lumbar punctures.…”

Evolving Evidence in Idiopathic Intracranial Hypertension

“…Wibroe et al used a standardized protocol to image the optic nerve head and found that optic disc drusen were no more commonly found, as compared to rates seen in the general population. Importantly nearly one third demonstrated hyperreflective lines, which the authors propose as a consequence of optic disc crowding, with four fifths having PHOMS by three months with no statistical difference in the retinal nerve fibre layer global thickness or in the macular ganglion cell volume compared to patients without PHOMS [12].…”

“…Diagnosing and managing IIH can be challenging [2] and selected articles underlined the importance of the multidisciplinary team in joint pathways where specialists worked together to provide the best care for patients [1,6,8]. A number of articles investigated methods to aide diagnostic certainty and enable stratification of the disease [9][10][11][12]. An exploratory study used a handheld device to measure the photopic flash electroretinogram and record the photopic negative response.…”

An overview of peripapillary hyperreflective ovoid mass-like structures

“…IIH is an acquired condition involving raised intracranial pressure leading to papilledema and axonal damage [22,35]. Wibroe et al [35] examined 32 adult patients with IIH and found that 26 or 81.3% had PHOMS. PHOMS were present in 16 out of the 18 patients that had EDI-OCT performed initially at diagnosis.…”