Vitreoretinal Findings in Nonarteritic Ischemic Optic Neuropathy

Abstract

Background:Although nonarteritic anterior ischemic optic neuropathy (NAION) is considered a disorder that primarily affects the optic nerve head, optical coherence tomography (OCT) shows peripapillary and foveal subretinal fluid associated with optic disc swelling from NAION. We sought to further evaluate retinal and vitreous changes in patients with NAION.Methods:Patients diagnosed with NAION at the New England Eye Center between 2013 and 2017 were evaluated using OCT. The presence and distribution of subretinal fluid was analyzed. Evidence of other vitreoretinal changes, including vitreopapillary traction (VPT) and the presence of hyperreflective dots (HRD), were also determined.Results:Twenty-five eyes from 20 patients who presented within 4 weeks of symptom onset were assessed. Peripapillary subretinal fluid was seen in 16 eyes (64%). Of those eyes, the subretinal fluid extended into the macula in 4 eyes (16%). Visual acuity improved in 2 of 4 eyes after subfoveal fluid resolution. Intraretinal cysts located in the peripapillary region were seen in 8 eyes (32%), HRD were noted in 11 (44.0%). There was no evidence of VPT.Conclusions:A substantial number of patients with NAION have subretinal fluid on OCT, consistent with prior reports. Resolution of subfoveal fluid may result in some recovery of visual acuity. Other retinal changes, such as intraretinal cysts and HRD, are present but have unclear implications. We did not find evidence of a primary role of VPT in the pathophysiology of NAION.

Peripapillary Vitreous Traction Syndrome: Expanding the Spectrum of Anterior Optic Neuropathies

“…Unlike the atrophic enlargement of the C/D ratio by about 50% after 6 months in chronic NAION, 4 the C/D ratio in most of our PVT syndrome patients remained relatively stable from the acute to the chronic stage (This particular morphological feature was often observed by Bill Hoyt). Remarkably, the “disc-at-risk” phenomenon not only contributes to the compartment syndrome theory in NAION, but may also pose as a risk factor for the PVT syndrome, which would explain the frequent coexistence of vitreous traction with NAION observed by Thompson et al 5 and Molaie et al 6 A larger sample size of patients with the PVT syndrome would be needed to confirm whether a smaller C/D ratio at onset is a risk factor of PVT syndrome and whether this C/D ratio remains relatively unchanged in the chronic stage.…”

Papillary vitreous detachment as a possible accomplice in non-arteritic anterior ischaemic optic neuropathy

“…20 25 However, there are still some conflicting opinions on whether papillary vitreous detachment causes NAION. [26][27][28] Some studies have argued that papillary vitreous detachment is not related to classical NAION development because vitreopapillary traction was not detected in any eye with NAION using spectral domain optical coherence tomography (SD-OCT). 26 27 The traditional designation of 'vitreopapillary traction' is associated with a static angulated V-shaped hyaloid vitreous.…”