TY - JOUR

T1 - Diabetic papillopathy in patients with optic disc drusen

T2 - Description of two different phenotypes

AU - Becker, Daniel

AU - Larsen, Michael

AU - Lund-Andersen, Henrik

AU - Hamann, Steffen

N1 - Publisher Copyright: © The Author(s) 2022.

PY - 2023

Y1 - 2023

N2 - Purpose: To describe two cases of severe acute bilateral optic disc edema that occurred in patients with diabetes mellitus shortly after the initiation of intensified antihyperglycemic therapy. Methods: Retrospective observational case report. Case description: Two patients with type 1 diabetes presented for routine retinopathy screening with asymptomatic optic disc edema. One case was bilateral, the other unilateral. Neither patient had visual complaints. Both patients’ glycemia history was characterized by a recent bout of poor regulation and both had optic disc edema consistent with diabetic papillopathy in combination with prominent Optic disc drusen (ODD). The swelling that appeared to constitute the edematous diabetes-related component of the disease resolved within 10–12 weeks during which diabetes therapy was optimized. Visual field deficits were seen early on in both patients and had resolved to some extent in one patient after 9 months but persisted in the one affected eye in the other patient up to at least 30 months. Conclusion: Two cases of ODD-associated diabetic papillopathy were observed: One with classic, bilateral disc edema and minor visual field defects, the other with unilateral disc edema, severe visual field defects and a phenotype that resembled non-arteritic anterior ischemic optic neuropathy. The cases suggest that ODD may increase the risk of diabetic papillopathy, a condition that is associated with rapid glycemia reduction and crowded optic discs, which may combine to produce nerve fiber swelling and hypoperfusion with venous congestion in a compartment with limited room for expansion.

AB - Purpose: To describe two cases of severe acute bilateral optic disc edema that occurred in patients with diabetes mellitus shortly after the initiation of intensified antihyperglycemic therapy. Methods: Retrospective observational case report. Case description: Two patients with type 1 diabetes presented for routine retinopathy screening with asymptomatic optic disc edema. One case was bilateral, the other unilateral. Neither patient had visual complaints. Both patients’ glycemia history was characterized by a recent bout of poor regulation and both had optic disc edema consistent with diabetic papillopathy in combination with prominent Optic disc drusen (ODD). The swelling that appeared to constitute the edematous diabetes-related component of the disease resolved within 10–12 weeks during which diabetes therapy was optimized. Visual field deficits were seen early on in both patients and had resolved to some extent in one patient after 9 months but persisted in the one affected eye in the other patient up to at least 30 months. Conclusion: Two cases of ODD-associated diabetic papillopathy were observed: One with classic, bilateral disc edema and minor visual field defects, the other with unilateral disc edema, severe visual field defects and a phenotype that resembled non-arteritic anterior ischemic optic neuropathy. The cases suggest that ODD may increase the risk of diabetic papillopathy, a condition that is associated with rapid glycemia reduction and crowded optic discs, which may combine to produce nerve fiber swelling and hypoperfusion with venous congestion in a compartment with limited room for expansion.

KW - Diabetic macular edema < RETINA

KW - NEURO OPHTHALMOLOGY

KW - optic neuritis < NEURO OPHTHALMOLOGY

KW - optic neuropathy < NEURO OPHTHALMOLOGY

KW - retinal pathology / research < RETINA

KW - techniques of retinal examination < RETINA

U2 - 10.1177/11206721221100901

DO - 10.1177/11206721221100901

M3 - Journal article

C2 - 35570569

AN - SCOPUS:85132612271

VL - 33

SP - NP129-NP132

JO - European Journal of Ophthalmology

JF - European Journal of Ophthalmology

SN - 1120-6721

IS - 4

ER -