Vision Loss after Cranial Radiotherapy: Case Report and Review

Abstract

1.1.Background: The ocular manifestations of various types of radiation vary from patient to patient. As the primary sites of damage are endothelial cells, co-existing microvascular diseases, such as diabetes and hypertension, increase the risk of developing retinopathy and maculopathy from radiation treatment. Prompt recognition of findings and initiation of treatment may delay or decrease associated vision loss. 1.2.Case Report: A 62-year-old male presents to the emergency department complaining of persistent hiccups for three days. Further testing revealed right basal ganglia CNS lymphoma for which he received chemotherapy and external beam radiation. He was referred to the eye clinic from the oncology department with complaints of blurred vision in both eyes. His systemic medical history was remarkable for Insulin Dependent Diabetes Mellitus Type 2 and hypertension. On examination, the visual acuity was 20/40 in each eye. Fundus examination revealed cotton wool spots, macular edema and marked capillary non-perfusion in the posterior poles of both eyes. Over the course of a year, his vision deteriorated to 20/400 in each eye. Considering the patients good control of his underlying microvascular diseases, radiation retinopathy was considered likely etiology for the relatively rapid progression of retinal findings and concurrent worsening of vision. Despite a series of Intravitreal Avastin Injections administered in an attempt to stabilize vision, the patient’s vision was unable to be restored. 1.3.Conclusion: Extensive patient education is imperative for patients undergoing radiation treatment, due to ocular or periocular neoplasms, considering the various possible ocular manifestations. Coexisting microvascular diseases should be taken into consideration as they increase the risk of developing retinopathy. This case report reviews the histopathology, risk factors, natural course and long term sequelae of radiation treatment to familiarize the practicing eye care professional with contemporary evaluation and therapeutic considerations for this potentially vision threatening condition.