Retina

Case 64

Patient Presentation: A 24-year-old male was referred because of painless blurred vision (OD > OS) for 1 month. His past medical history was significant for a pineal tumour which was treated by craniospinal radiation (36 Gy, 54 Gy and then 59.4 Gy). He did not have diabetes or hypertension. On exam, visual acuity was 20/150 OD and 20/40-1 OS. Colour vision was 0/12 OD and 7/14 OS. There was no RAPD. OCT macula was performed and shown below. 

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Question: What is NOT seen on OCT macula? 

These abnormalities correlated with findings on fundoscopy:

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Question: What should immediately be done in the office? 

The patient’s blood pressure was 130s/80s.

Question: What is the likely cause of this patient’s presentation?

Question: How should this patient be managed? 

Question: If this patient were to undergo further craniospinal radiation, how would you treat to prevent worsening radiation retinopathy? 

References:

  1. Danesh-Meyer HV. Radiation-induced optic neuropathy. J Clin Neurosci. 2008;15(2):95-100.

  2. Fallico M, Chronopoulos A, Schutz JS, Reibaldi M. Treatment of radiation maculopathy and radiation-induced macular edema: A systematic review. Surv Ophthalmol. 2021;66(3):441-460. 

  3. Giuliari GP, Sadaka A, Hinkle DM, Simpson ER. Current treatments for radiation retinopathy. Acta Oncol. 2011;50(1):6-13. 

  4. Sahoo NK, Ranjan R, Tyagi M, Agrawal H, Reddy S. Radiation Retinopathy: Detection and Management Strategies. Clin Ophthalmol. 2021;15:3797-3809. Published 2021 Sep 8. doi:10.2147/OPTH.S219268

 

Learning Objectives:

  1. Interpreting OCT macula images in patients with radiation retinopathy

  2. Identify patients at risk for radiation retinopathy

  3. Understand principles in management for patients with radiation retinopathy