Optic Neuropathy
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Cureus ◽  
2021 ◽  
Maizatul Nadia Hassan ◽  
Wan Hazabbah Wan Hitam ◽  
Nurul Ain Masnon ◽  
Subash Govindasamy ◽  
Ahmad Razif Omar

Cancers ◽  
2021 ◽  
Vol 13 (21) ◽  
pp. 5327
Andreas Köthe ◽  
Loïc Feuvret ◽  
Damien Charles Weber ◽  
Sairos Safai ◽  
Antony John Lomax ◽  

Radiation-induced optic neuropathy (RION) is a rare side effect following radiation therapy involving the optic structures whose onset is, due to the low amount of available data, challenging to predict. We have analyzed a multi-institutional cohort including 289 skull-base cancer patients treated with proton therapy who all received >45 GyRBE to the optic apparatus. An overall incidence rate of 4.2% (12) was observed, with chordoma patients being at higher risk (5.8%) than chondrosarcoma patients (3.2%). Older age and arterial hypertension, tumor involvement, and repeated surgeries (>3) were found to be associated with RION. Based on bootstrapping and cross-validation, a NTCP model based on age and hypertension was determined to be the most robust, showing good classification ability (AUC-ROC 0.77) and calibration on our dataset. We suggest the application of this model with a threshold of 6% to segment patients into low and high-risk groups before treatment planning. However, further data and external validation are warranted before clinical application.

2021 ◽  
pp. 112067212110491
Ali Nouraeinejad

Radiation-induced optic neuropathy (RION) is a late complication of radiation therapy for brain and skull base tumors. RION leads to the devastating total vision loss in one or both eyes. Therefore, the early detection of RION is vital. Since visual symptoms and clinical signs of RION are not present at early stages of the radiation injury, it is essential to apply a diagnostic test to detect RION as early as possible in order to start therapeutic interventions. The author proposes to apply visual evoked potential (VEP) as a diagnostic test in the interval time after radiation therapy.

2021 ◽  
Vol 62 (10) ◽  
pp. 1449-1454
Sung Do Cho ◽  
Dong Hyun Kim ◽  
Hee Kyung Yang ◽  
Jeong Min Hwang

Purpose: To describe a patient with posterior ischemic optic neuropathy (PION) after cervical spine surgery who recovered after treatment.Case summary: A 51-year-old woman presented with eye pain and decreased visual acuity in the left eye, which had begun 8 hours after cervical spine surgery in the prone position. Her best-corrected visual acuity (BCVA) was 20/20 in the right eye and hand motion in the left eye; a relative afferent pupillary defect was present in the left eye. Ductions and versions were normal with pain in the left eye. The results of slit lamp examination, fundoscopic examination, fluorescein angiography, and optical coherence tomography were unremarkable in both eyes. Brain and orbital magnetic resonance imaging showed no abnormal findings in the visual pathway, such as brain infarction or intracranial artery stenosis. The patient was diagnosed with PION in the left eye. Because postoperative anemia had developed with a rapid decrease in hemoglobin from 14.7 g/dL to 9.9 g/dL, red blood cell (RBC) transfusion was performed together with intravenous high-dose steroid therapy and subcutaneous epoetin alfa injection. After 3 weeks, the patient’s BCVA improved to 20/22 in the left eye.Conclusions: Unilateral PION developed after cervical spine surgery in the prone position. Visual improvement was observed after RBC transfusion, intravenous high-steroid therapy, and subcutaneous epoetin alfa injection.

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Rika Tsukii ◽  
Yuka Kasuya ◽  
Shinji Makino

To report a patient with nonarteritic anterior ischemic optic neuropathy (NA-AION) occurring soon after the COVID-19 vaccination. A 55-year-old woman presented with a 4-day history of inferior visual field disturbance in the right eye 7 days after receiving the first dose of Pfizer-BioNTech COVID-19 vaccine. Examination revealed a best-corrected visual acuity of 20/20 in both eyes. A relative afferent pupillary defect was observed in the right eye. Fundoscopy revealed diffuse optic disc swelling in the right eye, which was prominent above the optic disc. Goldmann visual field testing identified an inferior altitudinal visual field defect with I/2 isopter in the right eye. Although typical complete inferior visual field defect was not detected, a diagnosis of NA-AION was made. The patient was followed without any treatment. During the 2-month follow-up period, the optic disc swelling was gradually improved, and visual acuity was maintained 20/20; however, the optic disc looked diffusely pale in the right eye. Although it is uncertain whether the development of NA-AION after COVID-19 vaccination was consequential or coincidental, we speculate that the close temporal relationship with COVID-19 vaccination suggests the possibility of vasculopathy on the microvascular network of optic nerve head as background of inflammatory or immune-mediated element to the timing of the onset of NA-AION. The aim of this case report is to present this biological plausibility and to elucidate potential ophthalmological complications.

Mengsha Zou ◽  
Dide Wu ◽  
Hongzhang Zhu ◽  
Xiahua Huang ◽  
Xiaojuan Zhao ◽  

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