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I.R. Wallace, D.A. Mulholland, J.R. Lindsay, Diabetic papillopathy: an uncommon cause of bilateral optic disc swelling, QJM: An International Journal of Medicine, Volume 105, Issue 6, June 2012, Pages 583–584, https://doi.org/10.1093/qjmed/hcr062
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A 60-year-old lady with type 2 diabetes mellitus was admitted with apparent bilateral papilloedema, detected by her optician. Fundoscopic findings on admission are shown in Figure 1A and B.
She was diagnosed with type 2 diabetes mellitus in 1992 and treated with metformin, acarbose and gliclazide. She had no evidence of macrovascular complications, neuropathy or retinopathy on previous regular optometry assessments. She had Stage 3 chronic kidney disease due to histologically proven diabetic nephropathy and lupus nephritis (estimated glomerular filtration rate 37 mmol/ml/1.73 m2, albumin creatinine ratio 308.4 mg/mmol). Glycated haemoglobin (HbA1c) values had ranged from 6.0 to 7.0% during the preceding 5 years. Her lipid profile and blood pressure (BP) were controlled with statin, angiotensin converting enzyme inhibitor and angiotensin II receptor blocker therapy (Cholesterol 3.4 mmol/l, low-density lipoprotein cholesterol 1.7 mmol/l, BP 118/70 mmHg).
During her hospital admission raised intracranial pressure and a space occupying lesion were excluded by brain imaging (computed tomography, magnetic resonance imaging, magnetic resonance angiogram and magnetic resonance venogram) and lumbar puncture with normal opening pressure. Visual acuity was initially 6/9 bilaterally, Goldmann perimetry showed an arcuate field defect and generalized constriction; arteritis was excluded by fluorescein angiography. After this extensive testing she was diagnosed with diabetic papillopathy. Three months later her vision (6/6 bilaterally) and field defects have improved and signs of optic nerve swelling are resolving (Figure 1C and D).
