A surgical cause of pseudopapilledema

Abstract

We report a case of vitreopapillary traction mimicking optic disc swelling in a 73-year-old female with pseudophakia in the left eye and satisfactory postoperative vision of 6/6 and N5 two years prior. She presented with insidious onset of blurred vision in her left eye for two months. She was referred to Universiti Kebangsaan Malaysia Medical Centre (UKMMC) for further investigations of apparent optic disc swelling in the left eye by a general ophthalmologist. Her left eye vision was 6/18, pinhole 6/12, with near vision at N6. There was no relative afferent pupillary defect and anterior segment examination was normal. Examination of the posterior segment revealed a pink optic disc with blurred and elevated margins without hyperaemia. Vessels of the optic nerve head appeared normal and a lamellar macular hole was present with dull foveal reflex clinically. Right eye examination was normal. Optical coherence tomography (OCT) of the left eye using the raster line scan showed vitreopapillary traction surrounding the optic disc and vitreomacular traction (VMT) with lamellar macular hole. The patient was counselled for surgical release of VMT, however, she opted for conservative management.

Peripapillary vitreoretinal traction is a rare cause of pseudo-optic disc swelling. Thorough fundus examination with the help of OCT is crucial in making a prompt diagnosis, preventing unnecessary investigations, and evaluating other retinal pathologies which may benefit from treatment.