Vitrectomy and release of presumed epipapillary vitreous traction for treatment of nonarteritic anterior ischemic optic neuropathy associated with partial posterior vitreous detachment.

OBJECTIVE

To study the results of vitrectomy and release of epipapillary vitreous adhesions for the treatment of nonarteritic anterior ischemic optic neuropathy (NAION) associated with partial posterior vitreous detachment (PVD).

DESIGN

Prospective noncomparative interventional case series.

PARTICIPANTS

A series of 16 patients with clinical picture of NAION and small discs associated with partial PVD, diagnosed clinically and confirmed by optical coherence tomography and B-scan ultrasonography.

INTERVENTION: All patients underwent standard pars plana vitrectomy with meticulous removal of epipapillary vitreous adhesions within 1 month from the onset of visual symptoms.

MAIN OUTCOME MEASURES: Best-corrected visual acuity (BCVA), mean deviation of visual fields, and color vision testing.

RESULTS

In 15 patients BCVA improved (93.7%), mean preoperative BCVA was 6/38 (0.82+/-0.53 logarithm of the minimum angle of resolution [logMAR]), which improved to 6/18 (0.49+/-0.37 logMAR) postoperatively at 3 months. Nine eyes (56%) had > or =3 lines of visual improvement. Visual fields improved in 4 patients and color vision improved in 1 patient.

CONCLUSION

Vitreous traction from partial PVD may have a causative role in some cases of NAION associated with small discs. In these cases, vitrectomy and removal of epipapillary vitreous may result in improvement of visual acuity.