Gaze-evoked amaurosis from vitreopapillary traction.
OBJECTIVE
We report four patients with gaze-evoked amaurosis attributable to incomplete posterior vitreous detachment and ensuing vitreopapillary traction. We present these cases to illustrate and extend the spectrum of vitreopapillary syndromes and to draw attention to vitreopapillary traction and its expected manifestations in both optic disk appearance and optic nerve and retinal function.


METHODS
This is a retrospective observational case series culled from tertiary neuro-ophthalmology practice.


METHODS
Patients were evaluated with direct and indirect ophthalmoscopy, Hruby (precorneal) lens, three-mirror Goldmann contact lens, macular contact lens, formal perimetry, fundus photography, fluorescein angiography, and orbital ultrasound.


RESULTS
Four patients with gaze-evoked amaurosis had disk edema associated with a partial posterior vitreous separation. These patients were young and had atypical posterior vitreous detachments characterized by persisting vitreopapillary attachments.


CONCLUSIONS
Gaze-evoked amaurosis is a rare visual obscuration precipitated by changes in volitional gaze, usually associated with an underlying orbital mass. We extend its etiologies to implicate the vitreous through traction expressed at the optic disk. In our cases, vitreopapillary traction elevated the nerve head and eye movements precipitated transient visual phosphenes followed by gaze-evoked amaurosis caused by traction transmitted from the vitreous to superficial nerve fibers of the retina and disk.
Katz
Barrett
B
Departments of Ophthalmology, Neurology, and Neurosurgery, New York-Presbyterian Hospital, Weill Medical College of Cornell University, New York, New York, USA. Barret.Katz@eyetech.com
Hoyt
William F
WF
D000328:Adult; D001766:Blindness / Q000209:etiology*; D005128:Eye Diseases / Q000150:complications* / Q000175:diagnosis; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D008875:Middle Aged; D009887:Ophthalmoscopy; D009898:Optic Disk / Q000473:pathology; D009901:Optic Nerve Diseases / Q000150:complications* / Q000175:diagnosis; D009915:Orbit / Q000000981:diagnostic imaging; D010719:Phosphenes; D012189:Retrospective Studies; D012438:Saccades; D013577:Syndrome; D014463:Ultrasonography; D058609:Visual Field Tests; D014822:Vitreous Body / Q000000981:diagnostic imaging / Q000473:pathology*; D020255:Vitreous Detachment / Q000150:complications* / Q000175:diagnosis