Vitreopapillary Traction in Proliferative Diabetic Retinopathy

Vitreopapillary traction (VPT) may occur in eyes with or without DR (de Bustros et al., Arch Ophthalmol 105(2):196–199, 1987; Katz and Hoyt, Ophthalmology 102(2):349–354, 1995; Wisotsky et al., Am J Ophthalmol 126(1):137–139, 1998). It is characterized by vitreous traction on the disc margin through the fibrocellular membrane or an incompletely detached posterior hyaloid (Sebag, Eye (Lond) 6(Pt 6):541–552, 1992; Karatas et al., Eye (Lond) 19(6):676–682, 2005; Gabriel et al., Neuroophthalmology 44(4):213–8, 2020). The changes caused by prolonged traction on the disc were called “pseudopapilledema” by Schepens (Am J Ophthalmol 38(1:2):8–21, 1954). Diagnosis is based on clinical examination and/or OCT (Gabriel et al., Neuroophthalmology 44(4):213–218, 2020). VPT may damage the anterior optic nerve and cause visual function disturbance. Although the effect appears to be reversible, it might lead to irreversible optic nerve atrophy if left untreated. The possibility of visual function disturbance in the VPT was raised by De Bustros and associates in 1987 (de Bustros et al., Arch Ophthalmol 105(2):196–199, 1987). Kroll and associates further showed fundus photo, visual acuity, and VEP evidence of visual function improvement after traction release in isolated VPT patients in PDR (Kroll et al., Ophthalmologe 92(5):687–691, 1995; Kroll et al., Br J Ophthalmol 83(3):261–264, 1999). Early diagnosis and treatment of VPT can improve visual acuity and visual-evoked potentials and prevent progressive optic atrophy in diabetic eyes (Gabriel et al., Neuroophthalmology 44(4):213–218, 2020; Kroll et al., Ophthalmologe 92(5):687–691, 1995; Meyer et al., Acta Ophthalmol Scand 85(2):221–222, 2007). The clinical manifestations, disc changes, and surgical procedures will be discussed in this chapter.