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JAMA Ophthalmology Clinical Challenge
September 2015

Blurred Vision in a Woman Who Had Sphenoid Wing Meningioma

Author Affiliations
  • 1Illinois Eye and Ear Infirmary, Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago
JAMA Ophthalmol. 2015;133(9):1081-1082. doi:10.1001/jamaophthalmol.2015.1144

A woman in her early 40s with a history of recurrent meningioma of the right sphenoid wing after tumor resections, followed by adjuvant radiation, presented with fluctuating vision in the right eye for several months. On examination, her best-corrected visual acuity was 20/20 OD and 20/20 OS. An external examination revealed ptosis of the right upper eyelid covering 40% of the surface of the eye. In each eye, the pupil, intraocular pressure, motility, and confrontational visual field were normal. An anterior segment examination revealed mild nuclear sclerotic cataracts in both eyes. A dilated fundus examination of the right eye was notable for revealing infarcts in several nerve fiber layers along the arcades and nasal to the optic disc and a few microaneurysms nasal to the optic disc. Fluorescein angiography of the right eye (Figure, A) revealed multiple areas of staining nasal to the nerve and inferotemporal to the nerve and to the areas of pinpoint leakage within the macula. No abnormalities were noted during the fundus examination of her left eye. She was observed and followed up every 4 months. One year later, the patient complained of a 1-month history of gradually worsening vision in the right eye. Her visual acuity was 20/400 OD and 20/20 OS. A fundus examination of the right eye revealed thickening in the macular region. Optical coherence tomography of the right eye (Figure, B) revealed a central macular thickness of 454 μm and the presence of subretinal fluid in the subfoveal region.

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