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Published in Chung Nen Chua, Li Wern Voon, Siddhartha Goel, Ophthalmology Fact Fixer, 2017
Diabetic papillopathy is an uncommon complication of diabetes mellitus. It can occur in young or old patients and in type I or type II diabetes. There is no intracranial hypertension, the swelling may be unilateral or bilateral. Poor diabetic control is not a feature and laser photocoagulation does not help. The swelling may be the result of optic nerve head ischaemia, and telangiectasia may be seen, which can be confused with neovascularisation. The swelling usually resolves spontaneously and the vision is not affected.
Diagnosis of Optic Disc Oedema: Fundus Features, Ocular Imaging Findings, and Artificial Intelligence
Published in Neuro-Ophthalmology, 2023
Walid Bouthour, Valérie Biousse, Nancy J. Newman
In acute anterior ischaemic optic neuropathies (AION) optic disc oedema is by definition always present on fundus examination. Sectoral disc oedema strongly suggests NAION, whereas pallid, more diffuse oedema indicating optic disc infarction raises suspicion for an arteritic mechanism.4 Interestingly, some patients with or without AION in one eye may present with an asymptomatic sectoral disc oedema in the other eye, reflecting so-called ‘incipient’ NAION, considered a form of very early NAION.33,34 This can also be seen in diabetic patients (so-called ‘diabetic papillitis’ or more accurately, ‘papillopathy’, as the mechanism is probably microvasculopathic, akin to incipient NAION, rather than inflammation).35 Thus, ischaemic insults to the optic nerve head may present along a continuum: on one end, massive ischaemia such as arises from arteritic mechanisms causing optic nerve head infarction with profound vision loss; on the other end, mild oedema from asymptomatic incipient NAION or diabetic papillopathy.
Is There a True Neuroretinitis in Idiopathic Retinal Vasculitis, Aneurysms, and Neuroretinitis (IRVAN) Syndrome ?
Published in Ocular Immunology and Inflammation, 2022
Moncef Khairallah, Sana Khochtali, Imen Ksiaa
It is noteworthy that patients with IRVAN syndrome usually do not present with visual function alterations consistent with optic neuropathy or neuroretinitis.3,4,6,7 On the other hand, exudative maculopathy with a partial or complete macular star configuration is a hallmark of IRVAN syndrome that could be misinterpreted as a feature of neuroretinitis. Thanks to multimodal imaging, leaking arteriolar aneurysms at or near the optic disc can be easily identified as the main cause of optic disc swelling and fluorescein leakage and of macular star formation in patients with IRVAN syndrome.3,4,6,7 (Figures 1–3). Similar exudative maculopathy that also may masquerade as neuroretinitis has been associated with non-inflammatory ocular vascular diseases, such as systemic hypertension, branch retinal vein occlusion, retinal arterial macroaneurysm, and diabetic papillopathy.5
Ocular manifestations of endocrine disorders
Published in Clinical and Experimental Optometry, 2022
M Hossein Nowroozzadeh, Sarah Thornton, Alison Watson, Zeba A Syed, Reza Razeghinejad
Diabetic papillopathy is considered a diagnosis of exclusion in a diabetic patient with unilateral or bilateral disc oedema. Patients generally have mild vision loss and there may be visual field defects, including blind spot enlargement.22 This condition is likely related to decreased optic nerve head perfusion in the setting of diabetic vascular disease, although the mechanism has not been clearly defined. Fundoscopy may reveal prominent telangiectasias on the nerve and disc oedema in one or both eyes.23 Diabetic papillopathy has a generally benign course with visual improvement expected over weeks to months. There have been some reports of expedited recovery with the use of intravitreal triamcinolone acetate or intravitreal anti-vascular endothelial growth factor agents.24,25