Fluorescein angiography in nonischemic optic disc edema

Objective: To determine whether nonischemic optic disc edema is associated with significant delay in fluorescein angiographic optic disc filling. Methods: Fluorescein angiograms from 16 patients with acute papillitis, five with papilledema, and one with optic disc edema from orbital cavernous hemangioma were compared with those of age-matched controls. Early views of the optic disc were evaluated for onset of central retinal artery dye filling and both onset and completion of choroidal and prelaminar optic disc dye filling. Data were compared with our previously published figures for patients with nonarteritic anterior ischemic optic neuropathy (NAION) and a new group of patients aged 46 years and younger with NAION (NAIONy). Subgroup analysis was performed on data from patients with papillitis. Results: Mean onset or completion of filling was not significantly delayed compared with controls for the central retinal artery, choroid, or prelaminar optic disc in patients with nonischemic optic disc edema, including the subgroup of patients with papillitis. In comparison, significant delay had been detected for onset and filling of prelaminar disc in typical NAION; similar significant delay was noted in this study for patients with NAIONy. No patients with nonischemic optic disc edema (including those with papillitis) demonstrated delay of disc filling by at least 5 seconds, while this feature was detected in 76% of patients with typical NAION and 62% of those with NAIONy. Conclusions: Optic disc filling delay is common in typical NAION and NAIONy; it is not a feature of nonischemic optic disc edema. This characteristic may aid in the differentiation of NAION from papillitis.