- Madhura Tamhankar, MD
Madhura Tamhankar, MD
- Assistant Professor of Ophthalmology
- University of Pennsylvania
- Nicholas J Volpe, MD
Nicholas J Volpe, MD
- Tarry Professor and Chairman
- Department of Ophthalmology
- Northwestern Feinberg School of Medicine
Diabetic papillopathy (DP) is a term that is used to characterize a finding of unilateral or bilateral optic disc edema with variable visual loss seen in patients with diabetes. It can occur in patients with type 1 diabetes mellitus (DM) and type 2 DM irrespective of metabolic control or severity of diabetic retinopathy.
Specific criteria for the diagnosis of diabetic papillopathy and a clear differentiation of this entity from nonarteritic anterior ischemic optic neuropathy (NAION) have not been established . While diabetic papillopathy has a generally favorable prognosis and does not usually require treatment, it must be distinguished from more malignant processes such as papilledema, other infectious and inflammatory causes causing bilateral disc swelling, and those causing increased intracranial pressure.
This topic discusses diabetic papillopathy. NAION and other conditions causing optic disc swelling are discussed separately. (See "Nonarteritic anterior ischemic optic neuropathy: Epidemiology, pathogenesis, and etiologies" and "Nonarteritic anterior ischemic optic neuropathy: Clinical features and diagnosis" and "Nonarteritic ischemic optic neuropathy: Prognosis and treatment" and "Overview and differential diagnosis of papilledema".)
Diabetic papillopathy is rare with an estimated incidence of 0.5 percent . Initially described in younger patients with type 1 diabetes [3-7], subsequent publications have reported that DP also occurs in older individuals (up to 79 years old) with type 2 diabetes [8-10].
The pathogenesis of DP is uncertain. A diabetic microangiopathy has been proposed as an etiology, but no pathologic studies of DP have been reported to confirm or refute this theory. There is no clear association between DP and the state of metabolic control of the diabetes or with the stage of diabetic retinopathy [5,9]. Most reported cases of DP occur in patients with long-standing diabetes, but duration of diabetes is not proven to be a risk factor for DP [4,5,7,9].
- Hayreh SS, Zimmerman MB. Nonarteritic anterior ischemic optic neuropathy: clinical characteristics in diabetic patients versus nondiabetic patients. Ophthalmology 2008; 115:1818.
- Kim M, Lee JH, Lee SJ. Diabetic papillopathy with macular edema treated with intravitreal ranibizumab. Clin Ophthalmol 2013; 7:2257.
- Lubow M, Makley TA Jr. Pseudopapilledema of juvenile diabetes mellitus. Arch Ophthalmol 1971; 85:417.
- Appen RE, Chandra SR, Klein R, Myers FL. Diabetic papillopathy. Am J Ophthalmol 1980; 90:203.
- Barr CC, Glaser JS, Blankenship G. Acute disc swelling in juvenile diabetes. Clinical profile and natural history of 12 cases. Arch Ophthalmol 1980; 98:2185.
- Hayreh SS, Zahoruk RM. Anterior ischemic optic neuropathy. VI. In juvenile diabetics. Ophthalmologica 1981; 182:13.
- Pavan PR, Aiello LM, Wafai MZ, et al. Optic disc edema in juvenile-onset diabetes. Arch Ophthalmol 1980; 98:2193.
- Regillo CD, Brown GC, Savino PJ, et al. Diabetic papillopathy. Patient characteristics and fundus findings. Arch Ophthalmol 1995; 113:889.
- Bayraktar Z, Alacali N, Bayraktar S. Diabetic papillopathy in type II diabetic patients. Retina 2002; 22:752.
- Inoue M, Tsukahara Y. Vascular optic neuropathy in diabetes mellitus. Jpn J Ophthalmol 1997; 41:328.
- Hayreh SS. Diabetic papillopathy and nonarteritic anterior ischemic optic neuropathy. Surv Ophthalmol 2002; 47:600.
- Characteristics of patients with nonarteritic anterior ischemic optic neuropathy eligible for the Ischemic Optic Neuropathy Decompression Trial. Arch Ophthalmol 1996; 114:1366.
- Almog Y, Goldstein M. Visual outcome in eyes with asymptomatic optic disc edema. J Neuroophthalmol 2003; 23:204.
- Hayreh SS, Zimmerman MB. Incipient nonarteritic anterior ischemic optic neuropathy. Ophthalmology 2007; 114:1763.
- Sato T, Fujikado T, Hosohata J, et al. Development of bilateral, nonarteritic anterior ischemic optic neuropathy in an eye with diabetic papillopathy. Jpn J Ophthalmol 2004; 48:158.
- Wu GF, Balcer LJ. Endocrine and metabolic deficiency. Ophthalmol Clin North Am 2004; 17:427.
- Ostri C, Lund-Andersen H, Sander B, et al. Bilateral diabetic papillopathy and metabolic control. Ophthalmology 2010; 117:2214.
- Vaphiades MS. The disk edema dilemma. Surv Ophthalmol 2002; 47:183.
- Mansour AM, El-Dairi MA, Shehab MA, et al. Periocular corticosteroids in diabetic papillopathy. Eye (Lond) 2005; 19:45.
- Friedrich Y, Feiner M, Gawi H, Friedman Z. Diabetic papillopathy with macular star mimicking clinically significant diabetic macular edema. Retina 2001; 21:80.
- Nakamura M, Kanamori A, Nagai-Kusuhara A, et al. Serous macular detachment due to diabetic papillopathy detected using optical coherence tomography. Arch Ophthalmol 2009; 127:105.
- Ho AC, Maguire AM, Yannuzzi LA, et al. Rapidly progressive optic disk neovascularization after diabetic papillopathy. Am J Ophthalmol 1995; 120:673.
- Al-Haddad CE, Jurdi FA, Bashshur ZF. Intravitreal triamcinolone acetonide for the management of diabetic papillopathy. Am J Ophthalmol 2004; 137:1151.
- Ornek K, Oğurel T. Intravitreal bevacizumab for diabetic papillopathy. J Ocul Pharmacol Ther 2010; 26:217.
- Al-Dhibi H, Khan AO. Response of diabetic papillopathy to intravitreal bevacizumab. Middle East Afr J Ophthalmol 2011; 18:243.
- Willerslev A, Munch IC, Larsen M. Resolution of diabetic papillopathy after a single intravitreal injection of ranibizumab. Acta Ophthalmol 2012; 90:e407.
- Al-Hinai AS, Al-Abri MS, Al-Hajri RH. Diabetic papillopathy with macular edema treated with intravitreal bevacizumab. Oman J Ophthalmol 2011; 4:135.
- Feng J, Qu JF, Jiang YR. Resolution of diabetic papillopathy with a single intravitreal injection of bevacizumab combined with triamcinolone acetonide. Graefes Arch Clin Exp Ophthalmol 2013; 251:2651.
- Al-Hinai AS. Diabetic papillopathy with macular edema treated with intravitreal bevacizumab. Oman J Ophthalmol 2012; 5:138.
- Joob B, Wiwanitkit V. Intravitreal bevacizumab and diabetic papillopathy with macular edema. Oman J Ophthalmol 2012; 5:68.
- Sayin N, Kara N, Pekel G. Ocular complications of diabetes mellitus. World J Diabetes 2015; 6:92.
- Chin EK, Almeida DR, Sohn EH. Sustained and expedited resolution of diabetic papillopathy with combined PRP and bevacizumab. Can J Ophthalmol 2015; 50:e88.