Diabetic papillopathy. Patient characteristics and fundus findings
C. D. Regillo, G. C. Brown, P. J. Savino, G. A. Byrnes, W. E. Benson, W. S. Tasman and R. C. Sergott
Retina Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pa., USA.
OBJECTIVE: To better define the spectrum of patient characteristics and
fundus findings in patients with a presumably unique clinical entity
referred to as diabetic papillopathy. DESIGN: Retrospective series.
SETTING: A university-based referral practice. METHODS: We retrospectively
reviewed the medical records of all diabetic patients with benign,
transient disc swelling who were evaluated at our institution from 1986 to
1992. Data pertaining to patient demographics, visual acuity and symptoms,
disc and retinal findings, ancillary test results, and clinical course were
collected. RESULTS: Twenty-seven eyes of 19 patients met the study
definition of diabetic papillopathy. Patients were generally older (mean
age, 50 years) and of a broader age range (19 to 79 years) compared with
those in prior reports. Two thirds of patients had type II diabetes. Disc
swelling was consistently hyperemic and, on average, resolved within 3.7
months. Macular edema was a frequent associated finding (70% of eyes) as
was significant capillary nonperfusion (52% of tested eyes). Only four eyes
(15%) had final visual acuities of less than 20/50 and each had prominent
macular edema. Cup-disc ratio analysis of uninvolved eyes revealed a
significantly small physiologic cup. CONCLUSIONS: The clinical profile of
diabetic papillopathy can be expanded to include people who are older or
have type II diabetes and that affected eyes commonly have macular edema or
retinal vascular changes that can adversely affect the visual outcome.
Last, a small physiologic cup may represent an anatomic predisposition to
the condition.
