299 J. Sebag (ed.), Vitreous: in Health and Disease, DOI 10.1007/978-1-4939-1086-1_17, © Springer Science+Business Media New York 2014 I. Introduction Vitreo-papillary adhesion (VPA) is characterized by persis- tent adhesion of the posterior vitreous cortex to the optic disc as a direct consequence of anomalous posterior vitreous detachment (PVD) [see chapter III.B. Anomalous PVD and Vitreoschisis]. The significance of this pathology has gained Vitreo-Papillary Adhesion and Traction Michelle Y. Wang, Alfredo A. Sadun, and J. Sebag III.E. M.Y. Wang, MD • J. Sebag, MD, FACS, FRCOphth, FARVO (*) VMR Institute for Vitreous Macula Retina, 7677 Center Avenue, suite 400, Huntington Beach, CA 92647, USA Doheny Eye Institute, Los Angeles, CA USA e-mail: michellewusc@gmail.com; jsebag@VMRinstitute.com A.A. Sadun, MD, PhD, FARVO Doheny Eye Institute/UCLA, Los Angeles, CA USA e-mail: alfredo.sadun@gmail.com Outline I. Introduction II. Anatomy A. Vitreo-Retinal Interface B. Vitreo-Papillary Interface III. Pathology A. Vitreo-Papillary Adhesion and Traction B. Retinal Disorders 1. Macular Diseases 2. Intraretinal Cysts 3. Vascular Disorders a. Peripapillary, Subretinal, and Intrapapillary Hemorrhage b. Diabetic Vitreo-Retinopathy c. Central Retinal Vein Occlusion C. Optic Neuropathies 1. Non-arteritic Anterior Ischemic Optic Neuropathy 2. Gaze-Evoked Amaurosis 3. Optic Nerve Pit Conclusion References Keywords Vitreous • Vitreo-papillary interface • Vitreo-papillary adhesion • Vitreo-papillary traction • Gaze-evoked amaurosis • Intraretinal cysts • Macular hole • Macular pucker • Non-arteritic anterior ischemic optic neuropathy • Optic nerve pit Key Concepts 1. The vitreo-papillary interface is different from the vitreo-retinal interface, as there is no inner limiting membrane and no posterior vitreous cortex, but there is firm adhesion of the peripapillary cortex to the rim of the optic disc. 2. Vitreo-papillary adhesion may contribute to a wide spectrum of maculopathies by altering the vector of tangential forces at the vitreo-macular interface, inducing intraretinal cystoid spaces as well as lamellar and even full-thickness macular holes. 3. Anomalous posterior vitreous detachment with vitreo-papillary traction may disturb the cellular architecture of the optic disc inducing or contribut- ing to optic neuropathies via the membrane of Elschnig and/or pathologic attachments.