Vitreo-papillary adhesion and traction

Abstract

Vitreo-papillary adhesion (VPA) is characterized by persistent adhesion of the posterior vitreous cortex to the optic disc as a direct consequence of anomalous posterior vitreous detachment (PVD) [see chapter III.B. Anomalous PVD and vitreoschisis]. The significance of this pathology has gained increasing attention in the medical literature as traction at the adhesion site can lead to various pathologies depending on the directions of the force vector. As a result, VPA has been implicated in a wide range of retinal disorders such as macular holes and macular puckers, intraretinal cysts, and vascular disorders including peripapillary/subretinal/intrapapillary hemorrhages, proliferative diabetic vitreo-retinopathy, and central retinal vein occlusion. Due to direct traction on the optic disc, it may also play a role in a number of optic neuropathies such as non-arteritic anterior ischemic optic neuropathy, gaze-evoked amaurosis, and optic nerve pit. Optical coherence tomography (OCT) provides direct visualization of the vitreo-papillary interface, allowing us to better understand the underlying pathophysiology of vitreo-papillary adhesion and traction.