- Eye Hospital, The First Affiliated Hospital of Harbin Medical University, Harbin 150000, China;
Diabetic vitreopapillary traction syndrome (DVPT) is an important complication of diabetic eye disease, caused by persistent mechanical traction exerted by the vitreous on the optic disc and its surrounding tissues, It can lead to severe consequences such as visual impairment and visual field defects. The core mechanisms involve diabetic vitreous remodeling (including hyperglycemia-induced vitreous liquefaction, abnormal cross-linking, and anomalous posterior vitreous detachment) and the fibrovascular proliferation-traction vicious cycle, both contributing to the initiation and progression. Regarding diagnosis, optical coherence tomography is the cornerstone for visualizing vitreo-papillary anatomical relationships. B-scan ultrasonography is valuable in cases with opaque media. Visual field testing assesses the extent of retinal nerve fiber layer involvement. Fluorescein fundus angiography reveals disruption of the blood-retinal barrier on the optic disc surface. Optical coherence tomography angiography shows promise as a novel tool for early diagnosis and dynamic monitoring by quantifying microvascular abnormalities in the optic disc region. For treatment, conservative observation is suitable for patients with mild symptoms and stable visual function. For those experiencing progressive visual impairment, significant disc edema, or concurrent complications of diabetic retinopathy requiring intervention, active consideration of pars plana vitrectomy is warranted. Future research can focus on neuroprotection and revasrearization strategies, the quantitative relationship between traction intensity and optic nerve injury, and the optimization of individualized treatment strategies based on mechanisms, thereby further improving the diagnosis and treatment level of DVPT.
Copyright © the editorial department of Chinese Journal of Ocular Fundus Diseases of West China Medical Publisher. All rights reserved
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- 1. Babaeva DB, Shishkin MM, Fayzrakhmanov RR. Biomechanics of diabetic vitreopapillary traction syndrome[J]. Vestn Oftalmol, 2024, 140(2): 78-82. DOI: 10.17116/oftalma202414002178.
- 2. Gabriel RS, Boisvert CJ, Mehta MC. Review of vitreopapillary traction syndrome[J]. Neuroophthalmology, 2020, 44(4): 213-218. DOI: 10.1080/01658107.2020.1725063.
- 3. Rumelt S, Karatas M, Pikkel J, et al. Optic disc traction syndrome associated with central retinal vein occlusion[J]. Arch Ophthalmol, 2003, 121(8): 1093-1097. DOI: 10.1001/archopht.121.8.1093.
- 4. Wang MY, Nguyen D, Hindoyan N, et al. Vitreo-papillary adhesion in macular hole and macular pucker[J]. Retina, 2009, 29(5): 644-650. DOI: 10.1097/IAE.0b013e31819e0d92.
- 5. de Bustros S, Thompson JT, Michels RG, et al. Vitrectomy for progressive proliferative diabetic retinopathy[J]. Arch Ophthalmol, 1987, 105(2): 196-199. DOI: 10.1001/archopht.1987.01060020050026.
- 6. Kroll P, Wiegand W, Schmidt J. Vitreopapillary traction in proliferative diabetic vitreoretinopathy[J]. Br J Ophthalmol, 1999, 83(2): 261-264. DOI: 10.1136/bjo.83.3.261.
- 7. Karatas M, Ramirez JA, Ophir A. Diabetic vitreopapillary traction and macular oedema[J]. Eye (Lond), 2005, 19(6): 676-682. DOI: 10.1038/sj.eye.6701622.
- 8. Babayeva DB, Shishkin MM, Fayzrakhmanov RR, et al. Vitreopapillary traction syndrome in patients with proliferative diabetic retinopathy[J]. Vestn Oftalmol, 2021, 137(6): 38-44. DOI: 10.17116/oftalma202113706138.
- 9. Sebag J. Anatomy and pathology of the vitreo-retinal interface[J]. Eye (Lond), 1992, 6(Pt 6): 541-552. DOI: 10.1038/eye.1992.119.
- 10. Foos RY, Roth AM. Surface structure of the optic nerve head. 2. Vitreopapillary attachments and posterior vitreous detachment[J]. Am J Ophthalmol, 1973, 76(5): 662-671. DOI: 10.1016/0002-9394(73)90560-6.
- 11. Foos RY. Vitreoretinal juncture over retinal vessels[J]. Albrecht Von Graefes Arch Klin Exp Ophthalmol, 1977, 204(4): 223-234. DOI: 10.1007/BF00415316.
- 12. Anderson DR. Ultrastructure of the optic nerve head[J]. Arch Ophthalmol, 1970, 83(1): 63-73. DOI: 10.1001/archopht.1970.00990030065013.
- 13. Arnold AC. Vascular supply of the optic nerve head: implications for optic disc ischaemia[J]. Br J Ophthalmol, 2023, 107(5): 595-599. DOI: 10.1136/bjo-2022-322254.
- 14. Hiscott P, Waller HA, Grierson I, et al. The extracellular matrix of reparative tissue in the vitreous: fibronectin production in proliferative diabetic retinopathy membranes[J]. Eye (Lond), 1993, 7(Pt 2): 288-292. DOI: 10.1038/eye.1993.62.
- 15. Shibahara T, Ago T, Nakamura K, et al. PDGFR β-positive cell-mediated post-stroke remodeling of fibronectin and laminin α2 for tissue repair and functional recovery[J]. J Cereb Blood Flow Metab, 2023, 43(4): 518-530. DOI: 10.1177/0271678X221145092.
- 16. Karve IP, Taylor JM, Crack PJ. The contribution of astrocytes and microglia to traumatic brain injury[J]. Br J Pharmacol, 2016, 173(4): 692-702. DOI: 10.1111/bph.13125.
- 17. Zhao JP, Ma ZZ, Chen S, et al. Optic nerve lesions in diabetic rats: blood flow to the optic nerve, permeability of micro blood vessels and histopathology[J]. Int J Ophthalmol, 2010, 3(4): 291-294. DOI: 10.3980/j.issn.2222-3959.2010.04.03.
- 18. 黄厚斌. 玻璃体间隙及临床应用[J]. 眼科, 2023, 32(3): 177-181. DOI: 10.13281/j.cnki.issn.1004-4469.2023.03.001.Huang HB. Vitreous space and its clinical applications[J]. Ophthalmol CHN, 2023, 32(3): 177-181. DOI: 10.13281/j.cnki.issn.1004-4469.2023.03.001.
- 19. 龚轶, 邵彦, 李筱荣. 糖尿病玻璃体性状特点及其与增殖性糖尿病视网膜病变的关系[J]. 国际眼科杂志, 2023, 23(9): 1482-1485. DOI: 10.3980/j.issn.1672-5123.2023.9.11.Gong Y, Shao Y, Li XR. Vitreous properties in patients with diabetes mellitus and its relationship with proliferative diabetic retinopathy[J]. Int Eye Sci, 2023, 23(9): 1482-1485. DOI: 10.3980/j.issn.1672-5123.2023.9.11.
- 20. Kang SW, Hyung SM, Choi MY, et al. Induction of vitreolysis and vitreous detachment with hyaluronidase and perfluoropropane gas[J]. Korean J Ophthalmol, 1995, 9(2): 69-78. DOI: 10.3341/kjo.1995.9.2.69.
- 21. Johnson MW. Posterior vitreous detachment: evolution and complications of its early stAGE[J]. Am J Ophthalmol, 2010, 149(3): 371-382. DOI: 10.1016/j.ajo.2009.11.022.
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