Evaluation of Peripapillary Vitreous Dynamics in Patients with Acute Nonarteritic Anterior Ischemic Optic Neuropathy

To evaluate peripapillary and vitreomacular interface configurations using spectral-domain optical coherence tomography (SD-OCT) in patients with acute nonarteritic anterior ischemic optic neuropathy (NAION) and to compare findings with age-matched controls.

This single-center, retrospective, observational study included 60 patients with acute NAION and 60 age- and sex-matched healthy controls. Circumpapillary retinal nerve fiber layer scans and macular SD-OCT images were analyzed. Assessed peripapillary vitreoretinal interface parameters included peripapillary vitreoretinal adhesion, vitreoretinal traction, complete peripapillary vitreous detachment, peripapillary folds, superficial vascular protrusions, and hyperreflective vitreous dots. Vitreomacular interface characteristics were also evaluated.

Peripapillary vitreoretinal adhesion was more frequently observed in NAION eyes compared with controls (50% vs. 25%, p=0.04). Hyperreflective vitreous dots were significantly more common in NAION eyes (68.3% vs. 8.3%; p<0.001), with a higher mean count (5.31±6.05 vs. 0.50±1.54; p<0.001). Peripapillary folds were also more prevalent in NAION (41.7% vs. 1.7%; p<0.001). Although peripapillary superficial vascular protrusions were common in both groups, mean counts differed significantly (p<0.001). Among 34 NAION eyes with longitudinal follow-up, 29.4% demonstrated interval changes in vitreoretinal interface configuration.

Acute NAION is associated with distinct peripapillary vitreoretinal interface characteristics detectable by SD-OCT. These findings highlight structural differences in vitreoretinal interface configuration in acute NAION. However, their temporal relationship to ischemic injury remains uncertain.