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 �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. © 2007 American Academy of Ophthalmology