Papillary Vitreous Detachment as a Possible Accomplice in NAION
abstract
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Access this abstract nowAIM
To evaluate the role of papillary vitreous detachment in the pathogenesis of non-arteritic anterior ischaemic optic neuropathy (NAION) by comparing the features of vitreopapillary interface between NAION patients and normal individuals.
METHODS
This study included 22 acute NAION patients (25 eyes), 21 non-acute NAION patients (23 eyes) and 23 normal individuals (34 eyes). All study participants underwent swept-source optical coherence tomography to assess the vitreopapillary interface, peripapillary wrinkles and peripapillary superficial vessel protrusion. The statistical correlations between peripapillary superficial vessel protrusion measurements and NAION were analysed. Two NAION patients underwent standard pars plana vitrectomy.
RESULTS
Incomplete papillary vitreous detachment was noted in all acute NAION patients. The prevalence of peripapillary wrinkles was 68% (17/25), 30% (7/23) and 0% (0/34), and the prevalence of peripapillary superficial vessel protrusion was 44% (11/25), 91% (21/23) and 0% (0/34) in the acute, non-acute NAION and control groups, respectively. The prevalence of peripapillary superficial vessel protrusion was 88.9% in the eyes without retinal nerve fibre layer thinning. Furthermore, the number of peripapillary superficial vessel protrusions in the superior quadrant was significantly higher than that in the other quadrants in eyes with NAION, consistent with the more damaged visual field defect regions. Peripapillary wrinkles and visual field defects in two patients with NAION were significantly attenuated within 1 week and 1 month after the release of vitreous connections, respectively.
CONCLUSION
Peripapillary wrinkles and superficial vessel protrusion may be signs of papillary vitreous detachment-related traction in NAION. Papillary vitreous detachment may play an important role in NAION pathogenesis.
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Additional Info
Disclosure statements are available on the authors' profiles:
Papillary vitreous detachment as a possible accomplice in non-arteritic anterior ischaemic optic neuropathy
Br J Ophthalmol 2024 Mar 20;108(4)607-612, D Li, S Sun, J Liang, Y Yue, J Yang, Y Zhi, X Zhang, R Yu, X LiFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
In this study, the authors "evaluated the role of papillary vitreous detachment in the pathogenesis of non-arteritic anterior ischaemic optic neuropathy (NAION) by comparing the features of the vitreopapillary interface between patients with NAION and normal individuals." They concluded that "peripapillary wrinkles and superficial vessel protrusion may be signs of papillary vitreous detachment–related traction in NAION" and postulated that papillary vitreous detachment may have a significant role in the pathogenesis of NAION. They related their findings to the hypothesis of Parsa and Hoyt, which was termed "papillary vitreous detachment neuropathy." In this regard, the authors offered the presence of peripapillary wrinkles and superficial vessel profusion in support. In essence, there is traction caused by the detaching vitreous in the papillary vessels.
Other factors that may contribute to the pathophysiology of the process, such as the vitreous separation speed at the papilla level and age-related axonal fragility, are discussed. It is interesting that the authors cited cases in which the release of vitreous connections ameliorated visual field defects but did not result in complete recovery. In a concluding remark, the authors stated that "focusing on the vitreous status of such patients may be instructive for therapeutic intervention in the affected eyes and assessment and follow-up of the contralateral eyes." Nevertheless, they do not appear to advocate for vitrectomy at any stage of the process. It would have been helpful if the authors had tied these findings to other risk factors for NAION, which tend to emphasize ciliary artery involvement rather than remote from the anatomic region that is the focus of this study.