Spectral-Domain Optical Coherence Tomography of the Vitreopapillary Interface in Acute Nonarteritic Anterior Ischemic Optic Neuropathy.

PURPOSE: To use spectral-domain optical coherence tomography (SD-OCT) to assess whether epipapillary vitreous traction from evolving posterior vitreous detachment (PVD) is mechanistically involved in the pathogenesis of nonarteritic anterior ischemic optic neuropathy (NAION). DESIGN: Retrospective cohort study. METHODS: Setting: Single academic center. Patient or Study Population: Eighty eyes in 74 subjects presenting within 2 weeks of symptom onset of NAION. Intervention or Observation Procedures: SD-OCT imaging of the optic nerve head, macula, and peripapillary retinal nerve fiber layer (pRNFL) were reviewed for PVD and vitreopapillary traction (VPT). MAIN OUTCOME MEASURES: Prevalence and incidence of PVD and VPT, logMAR best-corrected visual acuity (BCVA), mean deviation (MD) on automated perimetry, and pRNFL thickness at presentation and final follow-up. RESULTS: The co-prevalence of PVD at the time of acute presentation for NAION was 30% (n = 24/80). This was similar to the prevalence of PVD in contralateral uninvolved eyes (34.5%, n = 19/55). In 8 NAION eyes, PVD had been documented prior to the onset of NAION. No eyes had SD-OCT evidence of VPT on presentation or final follow-up. Only 5 eyes developed a PVD following the development of NAION, and this typically occurred months after resolution of optic disc edema. When comparing eyes with PVD and without PVD, there was no significant difference in BCVA, MD, and pRNFL thickness at baseline, final follow-up, or the change from baseline to final follow-up (all P > .10). CONCLUSIONS: VPT was not mechanistically related to the development of classic NAION. Preexisting PVD did not preclude the future development of NAION. The co-prevalence of PVD with acute NAION had no impact on final visual outcome.

Duke Scholars

Author Sidney Maloch Gospe III Ophthalmology, Neuro-Ophthalmology