Ultrastructural changes detected using swept-source optical coherence tomography in severe vitreopapillary traction: a case report

ABSTRACT Vitreopapillary traction is an uncommon condition characterized by strong adhesion and the traction of the posterior hyaloid onto the optic disc and peripapillary retina, leading to optic disc elevation and visual loss. An 85-year-old man presented with a 6-month history of slow, progressive visual loss in the left eye along with optic disc edema. Swept-source optical coherence tomography B-scans revealed circumpapillary anterior-posterior persistent traction of dense vitreous strands onto the optic disc. Visual field examination demonstrated mild, generalized, diffuse sensitivity loss and blind-spot enlargement. A 25-gauge posterior vitrectomy was performed with posterior hyaloid separation from the optic disc, resulting in significant anatomical and visual improvement. In conclusion, swept-source optical coherence tomography aids in understanding the mechanism underlying visual loss in vitreopapillary traction. Moreover, posterior vitrectomy can effectively promote anatomical and visual improvements in these cases.

摘要 玻璃体视神经乳头牵引（Vitreopapillary traction）是一种少见病症，以玻璃体后皮质与视神经乳头及视神经乳头周围视网膜的紧密粘连及牵拉为特征，可导致视神经乳头隆起与视力丧失。一名85岁男性患者，因左眼缓慢进行性视力丧失伴视神经乳头水肿就诊，病程6个月。扫频源光学相干断层扫描（Swept-source optical coherence tomography）B扫描显示，视乳头周围存在致密玻璃体条索对其施加前后向持续性牵拉。视野检查提示存在轻度广泛性弥漫性敏感度下降及生理盲点扩大。患者接受25G玻璃体后切除术，完成玻璃体后皮质与视神经乳头的分离，术后解剖结构与视力均获得显著改善。综上，扫频源光学相干断层扫描有助于明确玻璃体视神经乳头牵引患者视力丧失的潜在机制，而玻璃体后切除术可有效改善此类患者的解剖结构与视力预后。