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Improved Vision from Severe Compressive Optic Neuropathy by Apical Cavernous Hemangioma.

Kang H, Takahashi Y, Nishimura K, Yasuda M, Akutsu H, Kakizaki H - Case Rep Ophthalmol (2016)

Bottom Line: The optic nerve was compressed by both the tumor and the superior rectus muscle/levator palpebrae superioris complex.Histopathologic examination confirmed a cavernous hemangioma.One year after the surgery, her visual acuity and CFF improved to 1.0 and 32 Hz OD, respectively.

View Article: PubMed Central - PubMed

Affiliation: Department of Oculoplastic, Orbital and Lacrimal Surgery, Aichi Medical University Hospital, Japan; Department of Ophthalmology, University of Seonam College of Medicine, Presbyterian Medical Center, Jeonju-si, South Korea.

ABSTRACT
A 59-year-old woman had a 1-year history of right vision loss. Her visual acuity was then 0.01 OD, and the critical flicker frequency (CFF) was 8 Hz OD. Goldmann perimetry examination showed inferior suppression of the right visual field center. Funduscopic examination revealed normal coloring of the right optic disc. Imaging studies showed an apical oval tumor. The optic nerve was compressed by both the tumor and the superior rectus muscle/levator palpebrae superioris complex. The tumor was dissected from the surrounding tissues and completely extracted. Histopathologic examination confirmed a cavernous hemangioma. The patient underwent three cycles of postoperative steroid pulse therapy. One year after the surgery, her visual acuity and CFF improved to 1.0 and 32 Hz OD, respectively. Her right visual field was within the normal range.

No MeSH data available.


Related in: MedlinePlus

a Goldmann perimetry showing inferior suppression of the visual field center in the right eye. b Right funduscopic examination showing normal coloring of the optic disc. c Axial T1-weighted MRI showing an oval tumor at the orbital apex (arrow). The mass was isointense to gray matter. d A coronal T2-weighted MRI showing a hyperintense tumor (blue arrow) to gray matter between the medial (yellow arrow) and inferior rectus muscles (yellow arrowhead). The optic nerve (blue arrowhead) is sandwiched by both the tumor and the superior rectus muscle/levator palpebrae superioris complex (green arrow). e Courses of best-corrected visual acuity and CFF. VA = Visual acuity.
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Figure 1: a Goldmann perimetry showing inferior suppression of the visual field center in the right eye. b Right funduscopic examination showing normal coloring of the optic disc. c Axial T1-weighted MRI showing an oval tumor at the orbital apex (arrow). The mass was isointense to gray matter. d A coronal T2-weighted MRI showing a hyperintense tumor (blue arrow) to gray matter between the medial (yellow arrow) and inferior rectus muscles (yellow arrowhead). The optic nerve (blue arrowhead) is sandwiched by both the tumor and the superior rectus muscle/levator palpebrae superioris complex (green arrow). e Courses of best-corrected visual acuity and CFF. VA = Visual acuity.

Mentions: A 59-year-old woman presented with a 1-year history of decreased vision in the right eye. She had previously been treated for eosinophilic sinusitis and asthma. The first ophthalmic examination revealed a visual acuity of 0.01 OD and 1.2 OS. She exhibited a right relative afferent pupillary defect. The critical flicker frequency (CFF), which decreases with optic nerve damage, was 8 Hz OD and 35 Hz OS (normal: >35 Hz). Goldmann perimetry showed inferior suppression of the right visual field center (fig. 1a), but no abnormalities on the left. The binocular single vision field could not be assessed because of the severely decreased vision in the right eye. Hertel exophthalmometry showed proptoses of 18.5 mm OD and 16.5 mm OS. A slit-lamp examination revealed no signs of ocular disease. A funduscopic examination showed normal coloring of the right optic disc (fig. 1b). Computed tomographic and magnetic resonance images (MRI) indicated an oval orbital mass located between the medial and inferior rectus muscles at the orbital apex (fig. 1c, d). The mass was isointense to gray matter on T1-weighted MRI and hyperintense to gray matter on T2-weighted MRI. Because the patient had asthma, we did not perform gadolinium-enhanced MRI. Although the optic nerve was compressed by both the tumor and the superior rectus muscle/levator palpebrae superioris complex, the inferior visual defect may be due to the compression by the muscle. Opacities were observed in the bilateral ethmoid, maxillary, and frontal sinuses.


Improved Vision from Severe Compressive Optic Neuropathy by Apical Cavernous Hemangioma.

Kang H, Takahashi Y, Nishimura K, Yasuda M, Akutsu H, Kakizaki H - Case Rep Ophthalmol (2016)

a Goldmann perimetry showing inferior suppression of the visual field center in the right eye. b Right funduscopic examination showing normal coloring of the optic disc. c Axial T1-weighted MRI showing an oval tumor at the orbital apex (arrow). The mass was isointense to gray matter. d A coronal T2-weighted MRI showing a hyperintense tumor (blue arrow) to gray matter between the medial (yellow arrow) and inferior rectus muscles (yellow arrowhead). The optic nerve (blue arrowhead) is sandwiched by both the tumor and the superior rectus muscle/levator palpebrae superioris complex (green arrow). e Courses of best-corrected visual acuity and CFF. VA = Visual acuity.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4836141&req=5

Figure 1: a Goldmann perimetry showing inferior suppression of the visual field center in the right eye. b Right funduscopic examination showing normal coloring of the optic disc. c Axial T1-weighted MRI showing an oval tumor at the orbital apex (arrow). The mass was isointense to gray matter. d A coronal T2-weighted MRI showing a hyperintense tumor (blue arrow) to gray matter between the medial (yellow arrow) and inferior rectus muscles (yellow arrowhead). The optic nerve (blue arrowhead) is sandwiched by both the tumor and the superior rectus muscle/levator palpebrae superioris complex (green arrow). e Courses of best-corrected visual acuity and CFF. VA = Visual acuity.
Mentions: A 59-year-old woman presented with a 1-year history of decreased vision in the right eye. She had previously been treated for eosinophilic sinusitis and asthma. The first ophthalmic examination revealed a visual acuity of 0.01 OD and 1.2 OS. She exhibited a right relative afferent pupillary defect. The critical flicker frequency (CFF), which decreases with optic nerve damage, was 8 Hz OD and 35 Hz OS (normal: >35 Hz). Goldmann perimetry showed inferior suppression of the right visual field center (fig. 1a), but no abnormalities on the left. The binocular single vision field could not be assessed because of the severely decreased vision in the right eye. Hertel exophthalmometry showed proptoses of 18.5 mm OD and 16.5 mm OS. A slit-lamp examination revealed no signs of ocular disease. A funduscopic examination showed normal coloring of the right optic disc (fig. 1b). Computed tomographic and magnetic resonance images (MRI) indicated an oval orbital mass located between the medial and inferior rectus muscles at the orbital apex (fig. 1c, d). The mass was isointense to gray matter on T1-weighted MRI and hyperintense to gray matter on T2-weighted MRI. Because the patient had asthma, we did not perform gadolinium-enhanced MRI. Although the optic nerve was compressed by both the tumor and the superior rectus muscle/levator palpebrae superioris complex, the inferior visual defect may be due to the compression by the muscle. Opacities were observed in the bilateral ethmoid, maxillary, and frontal sinuses.

Bottom Line: The optic nerve was compressed by both the tumor and the superior rectus muscle/levator palpebrae superioris complex.Histopathologic examination confirmed a cavernous hemangioma.One year after the surgery, her visual acuity and CFF improved to 1.0 and 32 Hz OD, respectively.

View Article: PubMed Central - PubMed

Affiliation: Department of Oculoplastic, Orbital and Lacrimal Surgery, Aichi Medical University Hospital, Japan; Department of Ophthalmology, University of Seonam College of Medicine, Presbyterian Medical Center, Jeonju-si, South Korea.

ABSTRACT
A 59-year-old woman had a 1-year history of right vision loss. Her visual acuity was then 0.01 OD, and the critical flicker frequency (CFF) was 8 Hz OD. Goldmann perimetry examination showed inferior suppression of the right visual field center. Funduscopic examination revealed normal coloring of the right optic disc. Imaging studies showed an apical oval tumor. The optic nerve was compressed by both the tumor and the superior rectus muscle/levator palpebrae superioris complex. The tumor was dissected from the surrounding tissues and completely extracted. Histopathologic examination confirmed a cavernous hemangioma. The patient underwent three cycles of postoperative steroid pulse therapy. One year after the surgery, her visual acuity and CFF improved to 1.0 and 32 Hz OD, respectively. Her right visual field was within the normal range.

No MeSH data available.


Related in: MedlinePlus