Vitrectomy and Release of Presumed Epipapillary Vitreous Traction for Treatment of Nonarteritic Anterior Ischemic Optic Neuropathy Associated with Partial Posterior Vitreous Detachment

Intravitreal bevacizumab for the treatment of nonarteritic anterior ischemic optic neuropathy: a prospective trial

“…Although a wide range of medical and surgical approaches have been employed for this condition, most have demonstrated little benefit and some significant risk. [1][2][3][4][5][6] However, one promising strategy involves the use of anti-inflammatory therapy in the acute stages of NAION. The theory behind this approach is that rapidly reducing swelling at the optic nerve head will reduce pressure in the crowded optic nerve head, thus opening up microvasculature and reducing post-ischemic nerve damage.…”

Nonarteritic anterior ischemic optic neuropathy: untreatable at present?

“…In 15 patients (93.7%), visual acuity improved; nine patients (56%) had at least three lines of visual improvement. However, others have subsequently questioned the results of this study [60], asserting that the OCT configuration described as 'partial posterior detachment' in the study actually represented the normal vitreous attachment to the optic disc in the older patient that has not yet suffered a posterior vitreous detachment, and the separation from the retina may have represented early liquefaction of the vitreous rather than traction on the optic disc [59].…”

“…Surgical release of epipapillary vitreous traction was evaluated in a series of 16 AION cases with small discs and partial posterior vitreous detachment demonstrated on OCT. Pars plana vitrectomy with removal of epipapillary adhesions was performed within 1 month of the onset of visual symptoms of NAION [59]. In 15 patients (93.7%), visual acuity improved; nine patients (56%) had at least three lines of visual improvement.…”

Optical Coherence Tomography and Optic Nerve Edema

“…In 1954, Schepens used the term pseudopapilledema when he demonstrated the histopathology of partially detached vitreous at the optic nerve head, usually in the context of co-existing retinal disease [ 49 ], such as proliferative diabetic retinopathy [ 50 ], central retinal vein occlusion [ 51 ], and non-arteritic ischemic optic neuropathy [ 52 ]. Using slit lamp biomicroscopy and ultrasonography, Katz and Hoyt observed peripapillary and intrapapillary hemorrhage in eight young patients with mildly dysplastic discs and persistent vitreopapillary traction, postulating that transmitted forces traumatized disc [ 55 ].…”