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Case report
Catastrophic vision loss from radiation-induced optic neuropathy
  1. Sultan Aldrees1 and
  2. Jonathan A Micieli1,2
  1. 1Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
  2. 2Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Dr Jonathan A Micieli; jonathanmicieli{at}


A 68-year-old woman presented with profound vision loss of 2-month duration in the right eye and 1-week duration in her left eye. This occurred in the context of craniopharyngioma that was twice resected and irradiated (54 Gy in 30 fractions) 9 months before her presentation. Ophthalmological examination revealed hand motion vision in the right eye and light perception vision in the left eye with poorly reactive pupils and bilateral optic disc pallor. A non-contrast MRI of the brain and sella showed significant reduction of the sellar mass. A repeat MRI of the brain and orbits with gadolinium showed pre-chiasmatic enhancement of both optic nerves. The diagnosis of radiation-induced optic neuropathy was made. Despite treatment with high-dose intravenous corticosteroids, 19 sessions of hyperbaric oxygen therapy, and 3 doses of intravenous bevacizumab, her vision worsened to no light perception in both eyes.

  • neuroopthalmology
  • visual pathway
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  • Contributors SA and JAM contributed to conception and design, drafting of manuscript, critical revision and data collection. JAM contributed to the final approval.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Next of kin consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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