Effect of vitreopapillary interface adhesions on optic disc: an OCTA study

This study aims to investigate the effects of vitreopapillary adhesion (VPA) on the optic disc (OD) microvascular structure using optical coherence tomography angiography (OCTA).

Thirty five patients with complete PVD at the posterior pole and residual optic disc adhesion (stage 3) (using the posterior vitreous detachment (PVD) staging by Uchino et al.) were included in the study. As a control group, 34 healthy individuals were included. RNFL thickness, rim area, disc area, cup/disc ratio, perfusion and flux index measurements were analysed with an optical coherence tomography angiography (OCTA).

While there was no statistically significant difference between the retinal nerve fiber layer thicknesses of both groups except the upper quadrant, the upper quadrant of RNFL thickness was found to be statistically significantly thinner in the vitreo-papillary adhesion (VPA) group. Mean value of disc area was 1.94 ± 0.38 in the adhesion group and 2.17 ± 0.42 in the control group (p = 0.060). Cup/disc ratios of VPA and control groups were 0.16 ± 0.15, 0.44 ± 0.14, respectively (p = 0.000).Cup volumes were also statistically significantly smaller in the adhesion group in parallel with the c/d ratio (0.02 ± 0.04, 0.16 ± 0.19 p = 0.000). Optic disc perfusions were 43.77% ± 2.22% in the adhesion group and 45.31 ± 1.20% in the control group (p = 0.003).

The significantly lower C/D ratio and cup volume in patients with vitreopapillary adhesion indicates that adhesion may occur more frequently in especially crowded discs. Although OCTA may be misleading in VPA patients, close monitoring of increased synretic vitreous gel traction on the OD with OCTA may be beneficial especially in patients with completed macular PVD. Monitoring VPA with OCTA may provide valuable insights into early vascular alterations that may contribute to non-arteritic anterior ischemic optic neuropathy (NAION) or papillary vitreous detachment neuropathy.