Radial Peripapillary Capillary Vascular Density on Optical Coherence Tomography Angiography in Pediatric Papilledema and Pseudopapilledema

PURPOSE: Distinguishing papilledema from pseudopapilledema in children remains a common and clinically challenging problem. We compared radial peripapillary capillary (RPC) vascular density measured by optical coherence tomography angiography (OCTA) in children with papilledema and pseudopapilledema. METHODS: This retrospective single-center study included children evaluated between June 2020 and June 2021 for unilateral or bilateral optic disc swelling, as well as healthy controls. Medical records and peripapillary OCTA images were reviewed, and eyes were classified as papilledema, pseudopapilledema, inflammatory optic disc edema, or healthy controls. Mean RPC vascular density was measured using a customized image-processing method. Visual acuity, Frisén grade, disc area, and retinal nerve fiber layer thickness were also recorded. RESULTS: Eighty-five eyes of 49 children were included: 16 with papilledema, 39 with pseudopapilledema, 11 with inflammatory optic disc edema, and 19 healthy controls. Mean age was 10.1 ± 3.6 years. Mean RPC vascular density was 41.4% in papilledema and 43.9% in pseudopapilledema, with a mean difference of 2.5% (95% CI, 0.2–4.8; P = 0.04). Healthy controls had higher RPC vascular density than papilledema eyes (44.8%; mean difference, 3.4% [95% CI, 0.8–6.0]; P = 0.01). RPC vascular density did not differ significantly between healthy controls and pseudopapilledema (mean difference, −0.9% [95% CI, −3.1 to 1.2]; P = 0.40). CONCLUSION: Children with papilledema had lower RPC vascular density than children with pseudopapilledema or healthy optic discs. OCTA-derived RPC vascular density may contribute to the diagnostic evaluation of pediatric optic disc swelling.