Studies by fluorescence photography of papilloedema in malignant hypertension1

Hyperaemia was noted to be an important feature of optic neuritis in 1860 by Graefe who described a 'swelling, reddening, and cloudiness of the optic disc which derives from my conception of mechanical hyperaemia'. Although a distinction in terms of aetiology is now made between papilloedema and true optic neuritis, Paton and Holmes (1911) noted almost identical ophthalmoscopic appearances in the two conditions. Duke-Elder (1940) attributed the increase of redness of the optic disc in papilloedema to the injection of small vessels. Michaelson and Campbell (1940) described an asymmetrical dense capillary network around the optic disc predominantly on its temporal side, and attributed papilloedema to leakage of plasma from this damaged peripapillary net. Niedermeier (1956) was able to demonstrate the leakage of methylene blue injected intravenously in white rabbits with experimental papilloedema. The presence of the peripapillary net was broadly confirmed by Ashton (1951) using an Indian ink injection technique, although some doubt on the layered pattern of this net was suggested by the trypsin digestion experiments of Touissant, Kuwabara, and Cogan (1961). The purpose of the present paper is to describe the use of fluorescence angiography to investigate patients with papilloedema, and particular attention is paid to vascular abnormalities in the capillaries of the optic disc and leakage from them.