A 16-year-old girl presented with gradually progressive vision loss in the right eye of 6 years duration. There was no history of trauma, pain, or redness. Her medical history was noncontributory. Best-corrected visual acuity (VA) was 10/300 in the right and 20/20 in the left eyes. The left eye was essentially normal. Fundus examination of the right eye revealed mild disc pallor, obscured disc margins from overlying vitreous condensation, and retinal traction caused by peripapillary membrane [Figure 1 - upper left]. Clinical findings were confirmed on optical coherence tomography (OCT) [Figure 1 - middle left]. Humphrey visual field (30-2) analysis showed paranasal and superotemporal defects [Figure 1 - lower left]. Investigations done to rule out tuberculosis (Quantiferon-TB gold test and Mantoux test), and sarcoidosis (high-resolution computed tomography of the chest and serum angiotensin-converting enzyme) were negative.
The patient underwent 25G pars plana vitrectomy with complete removal of posterior hyaloid, epiretinal, and peripapillary membranes and internal limiting membrane peeling with complete relief of traction. Postoperative recovery was uneventful. Six weeks later, fundus examination revealed relief of traction [Figure 1 - upper right] with settling retinal folds. OCT showed resolution of traction over the optic disc [Figure 1 - middle right]. Repeat visual fields revealed the improvement in field defects [Figure 1 - lower right]. VA was maintained at 10/300; improvement was impaired due to amblyopia. Six months later, examination revealed further reduction in retinal schitic changes with decrease in overall central macular thickness (384 microm) and VA being stable stable at 10/300.