Diabetic vitreopapillary traction and macular oedema

Abstract

Purpose To describe an association between optic disc traction and diabetic macular oedema (DME) unresponsive to laser treatment. Methods A retrospective review of all patients with DME who attended our clinic between September 2001 and November 2003 was undertaken. The patients had undergone ophthalmic history and examination, fluorescein angiography, and optical coherence tomography (OCT) of the macular area and optic nerve head (ONH). A total of 10 nonvitrectomized eyes that were found to have an elevation of the ONH secondary to vitreopapillary traction were included in the analysis. Eyes with additional traction at the posterior pole were excluded. Results Out of the 10 eyes (seven patients, aged 47-79 years) with vitreo-papillary traction, nine had previously undergone argon laser photocoagulation(s) for DME. In seven eyes (seven patients), OCT verified the vitreopapillary traction as the sole traction, whereas in the fellow eyes of three patients vitreomacular traction was evident as well. In the seven eyes with only vitreopapillary traction, OCT demonstrated parapapillary serous retinal detachment in two eyes and a diffuse DME in all eyes (mean foveal thickness, 3967144 lm). Maximal thickness of the papillo-macular bundle site was adjoining the elevated ONH in three eyes, and was maximal at the central macula in the other four eyes. Ultrasonography (n ¼ 5) revealed an incomplete detachment of the posterior hyaloid in each, adherent only at the ONH. Conclusions Diffuse DME unresponsive to laser treatment may be associated with vitreopapillary traction. Further studies should indicate whether these two phenomena could suggest a cause and effect in such eyes.

Extrafoveal vitreous traction associated with diabetic diffuse macular oedema

“…Extrafoveal traction sites are illustrated to be commonly associated with diffuse macular oedema. As far as we are aware (search through Entrez Pubmed), except for vitreopapillary traction associated with diffuse macular oedema, 16 this was not previously reported.…”

“…[13][14][15] In eyes with non-proliferative or proliferative diabetic retinopathy, it has been reported, using optical coherence tomography (OCT), that a vitreous traction at the optic nerve head (ONH) may result in diffuse oedema and/ or serous retinal detachment located between the ONH and the macula. 16 Pars plana vitrectomy (PPV) was found commonly beneficial in eyes with diffuse DME associated with vitreomacular traction. [17][18][19] The surgical outcome was variable in different studies if no vitreomacular traction was apparent.…”

“…Except for vitreopapillary traction, 16 earlier studies on DME without vitreomacular traction did not regularly mention or rule out extrafoveal traction. In that regard, reports on PPV outcome for eyes with macular oedema, without vitreomacular traction, are diverse.…”

Cystoid foveal oedema in symptomatic inner lamellar macular holes

“…Recently, high-resolution imaging techniques, mainly OCT, were found useful in the visualization of retinal anatomy with near microscopic resolution, [4][5][6][7][8][9][10] and new data have been found regarding LMH: (a) best-corrected visual acuity (BCVA) as low as 20/200, 20/400 and counting fingers at 8 feet was reported in eyes with LMHs; [11][12][13] (b) several studies showed persistent vitreous adherence to the edge of the LMH, baring a potential for traction and LMH progression; [13][14][15] (c) two reports showed an LMH in each that underwent spontaneous transition to a full-thickness macular hole; 9,13 and (d) pars plana vitrectomy (PPV) and gas tamponade for symptomatic LMH improved visual acuity in most eyes, provided that it included peeling of the internal limiting membrane (ILM). [11][12][13] All of the above seem to give rise to a revised concern about LMHs in regards to their morphologic abnormalities, natural history, potential of worsening, and the possibility of beneficial surgery with reversibility of symptoms.…”

Evolution and management of diabetic tractional papillopathy: an optical coherence tomographic study

“…[1][2][3][4] Vision may be adversely affected; recovery follows spontaneous/surgical relief of VPT. 3,4 However, the need for vitrectomy has been questioned, as VPT has not been conclusively shown to be the sole cause of visual decline.…”