Diabetic tractional papillopathy: a new (and true) nosological entity?

Partial restoration of vision was achieved following vitrectomy in 15 of 17 eyes, ostensibly through removal of diabetic fibrovascular proliferations from the nasal part of the optic disc and relief of vitreopapillary traction which, for between 6 months and 6 years, had caused a reversible functional impairment of the papillomacular bundle via stretching and kinking of ganglion cell axons and additional or consecutive effects on their prelaminar blood supply. Eyes with such features (that is, with traction primarily localised nasally on the disc and unaccountably affecting acuity without any associated disturbance of the central visual field) should be subjected to early vitrectomy in order to prevent irreversible long term damage to central vision. This is the recommendation of Kroll and colleagues in a report which is published in this issue of theBJO (p 261) and which merits the careful attention of all ophthalmologists involved in the management of diabetic eye disease. Indeed, some will already be asking—if this entity is so common, how have I failed to recognise it for all these years?

Diabetic papillopathy (that is, disc swelling without any tractional component) has proved difficult to …