Vitreomacular traction associated with papillitis
A 34-year-old woman presented with right eye blurry vision and discomfort one month after delivering her second child. Her right eye had a visual acuity of 20/20, a relative afferent pupillary defect, and no dyschromatopsia. Her exam revealed optic disc edema with no obvious vitritis (Fig. 1A). Macular optical coherence tomography (OCT) showed changes in the juxtapapillary retina (Fig. 2A). Fluorescein angiography demonstrated optic disc leakage. MRI showed minimal enhancement of the optic nerve head. After an infectious work-up returned negative, she was treated with oral corticosteroids.

One month later, she reported new acute painless vision loss in her right eye with a visual acuity of 20/60. The examination demonstrated peripapillary exudation and a repeat MRI was unremarkable. Nonetheless, she was treated with intravenous corticosteroids followed by an oral taper regimen. At her post-hospitalization visit, her exam (Fig. 1B) and OCT macula (Fig. 2B) revealed severe vitreomacular traction (VMT). After two weeks of observation, she noticed a dramatic improvement in her right eye vision shortly after participating in a recreational dance event. Repeat examination (Fig. 1C) and OCT imaging (Fig. 2C) showed significant interval improvement with separation of the posterior hyaloid face from the fovea. In follow-up one month later, her vision had returned to baseline.

VMT can be a mechanism of new or worsening vision loss in patients with papillitis.