Multimodal imaging in severe radiation optic neuropathy and radiation maculopathy

Author: Amine Zahaf (Tunisia)

Co-authors: Wafa Walha, Houda Lajmi, Besma Ben Achour, Wassim Hmaied

Purpose

Report the case of a patient presenting radiation optic neuropathy and radiation maculopathy after radiotherapy for undifferentiated nasopharyngeal carcinoma and emphasize the importance of OCT-Angiography in early diagnosis.

Setting/Venue

Radiation optic neuropathy and radiation maculopathy are rare complications that occur months to years after radiotherapy. It is probably the consequence of radiation necrosis of the retina and the anterior visual pathway and leads to irreversible painless visual loss that damages either one or both eyes.

Methods

Case report

Results

A 40-year-old women was treated with concomitant radio-chemotherapy for undifferentiated nasopharyngeal carcinoma invading the sphenoid sinus and the skull base in 2013. Five years later, she reported progressive vision loss in both eyes. On ocular examination, visual acuity was 8/10, p2 in both eyes. Anterior segment examination, intraocular pressure and photomotor reflex were normal. Posterior segment examination revealed marked retinal ischemia (cotton wool spots, exudates and telangiectasias) in macular region of both eyes. Fluorescein angiography did not show peripheral retinal ischemia. OCT A showed a decrease in macular vascular density, an enlargement and a distortion of the central avascular zone attesting macular ischemia. Evolution was marked by progressive decrease in visual acuity for both eyes. Fundus examination revealed aggravation of ischemic maculopathy and bilateral optic atrophy. OCT-SD showed decrease in retinal nerve fiber layer thickness. Peripapillary OCT-Angiography showed reduction in peripapillary vessel density and abnormalities of radial peripapillary capillary plexus.

Conlusions

Retinal multimodal imaging may be useful to have a precocious identification and classification of major optic neuropathy and retinopathy complications due to eye irradiation. Prevention and management of these complications are still limited. Further studies should be performed in order to produce treatment guidelines.

Financial Disclosure

There are no financial conflicts of interest to disclose