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April 2017

Optic Nerve Infiltration and Vitreous Seeding by a Cerebral Glioblastoma

Author Affiliations
  • 1Retina Division, Wilmer Eye Institute, Baltimore, Maryland
  • 2Department of Pathology, Johns Hopkins University, Baltimore, Maryland
JAMA Ophthalmol. 2017;135(4):400-401. doi:10.1001/jamaophthalmol.2016.5835

Cerebral high-grade astrocytomas typically result in poor outcomes for patients because their invasive nature makes resection difficult and because their resistance to chemoradiation usually leads to local recurrence. Herein, we report a case of acute vision loss with a dramatic presentation due to a recurrent cerebral malignant glioma.

A woman in her 40s with a recurrent cerebral malignant glioma in the left frontal lobe presented with blurred vision in the right eye. At presentation, she was undergoing treatment with systemic steroids, durvalumab (a PD-L1 inhibitor), and bevacizumab. Her initial examination revealed a visual acuity of 20/25 OU. The right eye field was full, but there was a right-sided relative afferent pupillary defect, an unremarkable anterior segment, and mild swelling of the optic disc. The left eye had a normal fundus and visual function. Magnetic resonance imaging of the brain revealed parenchymal disease progression, with enlargement and enhancement of the right optic nerve (Figure 1).

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