Optic neuropathy following radiotherapy for Cushing’s disease: case report and literature review

Ballian, Nikiforos; Androulakis, Ioannis I.; Chatzistefanou, Klio; Samara, Christianna; Tsiveriotis, Konstantinos; Kaltsas, Gregory

doi:10.1007/bf03401278

Cited by 14 publications

(9 citation statements)

References 30 publications

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“…Maximum radiation dose to the anterior visual pathway has been established as a significant determinant for the development of RION . The anterior visual pathway has been shown to tolerate no greater than 50 Gy of cumulative radiation in fractions less than 2 Gy, with the incidence of RION increasing markedly at higher levels . The incidence of RION following radiation treatment of head and neck or skull‐base tumours has been quoted as ranging from 0% for <50Gy to 16% for >70Gy .…”

Section: Introductionmentioning

confidence: 99%

“…1,3,4 The anterior visual pathway has been shown to tolerate no greater than 50 Gy of cumulative radiation in fractions less than 2 Gy, with the incidence of RION increasing markedly at higher levels. [5][6][7][8][9] The incidence of RION following radiation treatment of head and neck or skull-base tumours has been quoted as ranging from 0% for <50Gy to 16% for >70Gy. 10 Current EBRT treatment planning protocols limit maximum point-doses to the optic pathway to 54-55 Gy in 1.8-2 Gy fractions to minimize this complication.…”

Section: Introductionmentioning

confidence: 99%

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Risk factors for radiation‐induced optic neuropathy: a case–control study

Ferguson

Huecker

Huang

et al. 2017

Clinical Exper Ophthalmology

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Importance Identifying risk factors for RION could promote a more conservative approach to radiation treatment planning in vulnerable patients. Background This study explored possible factors beyond radiation dose associated with the development of radiation-induced optic neuropathy (RION) after external beam radiation therapy. Design This was a retrospective case-control study conducted at a university hospital tertiary care center. Participants Cases (n=14) meeting criteria for a diagnosis of RION by neuro- ophthalmologic exam were identified from a single-center neuro-ophthalmology database. Controls (n=31) without RION were selected from a single-center radiation oncology database. Methods Controls were matched to cases based upon maximum radiation dose to the optic apparatus. Patient characteristics and treatment parameters were interrogated by univariate analysis for attributes predisposing to RION. Main Outcome Measures The primary parameter was a significant association of patient characteristics or treatment parameters with RION. Results Controlling for radiation dosage, no significant associations for alternative risk factors were identified. Conclusions and Relevance These results support the literature suggesting that the primary risk factor for developing RION is radiation dosage and that additional, patient- and tumor-related risk factors may play only a minor role.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Risk factors for radiation‐induced optic neuropathy: a case–control study

Ferguson

Huecker

Huang

et al. 2017

Clinical Exper Ophthalmology

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“…MRI of the optic tract should study in detail, and this makes it a valuable tool in the diagnosis of RION in patients of radiation-induced disorders and also at the beginning of treatment. Although there are no specific imaging findings on CT and noncontrast MRI, contrast enhanced T1 weighted images show prominent enhancement throughout optic nerve [5]. This MRI finding of RION is non-specific.…”

Section: Discussionmentioning

confidence: 83%

A Sudden Vision Loss Requiring Urgent Radiological Evaluation: Radiation-Induced Optic Neuropathy

Kahraman¹,

Kahraman²,

Özdemi̇r³

et al. 2016

Med-Science

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“…Previous studies on radiation damage in the eye have addressed neuropathy of the optic nerve as well radiation retinopathy, maculopathy, cataracts, vitreous haemorrhage or secondary glaucoma after plaque therapy [7] and external beam radiotherapy [25]. …”

Section: Discussionmentioning

confidence: 99%

Changes in the micromorphology of the corneal subbasal nerve plexus in patients after plaque brachytherapy

et al. 2013

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BackgroundTo quantify the development of radiation neuropathy in corneal subbasal nerve plexus (SNP) after plaque brachytherapy, and the subsequent regeneration of SNP micromorphology and corneal sensation.MethodsNine eyes of 9 melanoma patients (ciliary body: 3, iris: 2, conjunctiva: 4) underwent brachytherapy (ruthenium-106 plaque, dose to tumour base: 523 ± 231 Gy). SNP micromorphology was assessed by in-vivo confocal microscopy. Using software developed in–house, pre-irradiation findings were compared with those obtained after 3 days, 1, 4 and 7 months, and related to radiation dose and corneal sensation.ResultsAfter 3 days nerve fibres were absent from the applicator zone and central cornea, and corneal sensation was abolished. The earliest regenerating fibres were seen at the one-month follow-up. By 4 months SNP structures had increased to one-third of pre-treatment status (based on nerve fibre density and nerve fibre count), and corneal sensation had returned to approximately two-thirds of pre-irradiation values. Regeneration of SNP and corneal sensation was nearly complete 7 months after plaque brachytherapy.ConclusionsThe evaluation of SNP micromorphology and corneal sensation is a reliable and clinically useful method for assessing neuropathy after plaque brachytherapy. Radiation-induced neuropathy of corneal nerves develops quickly and is partly reversible within 7 months. The clinical impact of radiation-induced SNP damage is moderate.

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Optic neuropathy following radiotherapy for Cushing’s disease: case report and literature review

Cited by 14 publications

References 30 publications

Risk factors for radiation‐induced optic neuropathy: a case–control study

Risk factors for radiation‐induced optic neuropathy: a case–control study

A Sudden Vision Loss Requiring Urgent Radiological Evaluation: Radiation-Induced Optic Neuropathy

Changes in the micromorphology of the corneal subbasal nerve plexus in patients after plaque brachytherapy

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