A 59-year-old man undergoing chemoradiotherapy with temozolomide according to the Stupp et al protocol1 (75 mg/m2/d continuously during radiotherapy followed by 6 cures of 5 days of temozolomide 200 mg/m2/d) for a high-grade cerebral astrocytoma located at the left parieto-temporo-occipital junction presented with rapidly progressive, painless loss of vision of the left eye for a few weeks. Visual acuity was hand motions. A relative afferent pupillary defect was observed. Anterior segment examination was normal. Ophthalmoscopy (Figure, A) revealed a massive, whitish tumor infiltrating the optic nerve associated with cellular seeding in the overlying vitreous. The right eye was normal. Intraocular extension of a cerebral glioblastoma is rare and associated with poor vision and survival.2 Glioblastoma located primarily in the optic nerve has been reported in fewer than 50 cases.3 Testing for the IDH-1 protein mutation, known to be correlated with larger glioblastomas with more satellite lesions, was negative in this patient.
Gratiot C, Froussart-Maille F, Delbarre M. High-grade Astrocytoma Responsible for Optic Nerve Infiltration With Vitreous Seeding. JAMA Ophthalmol. 2021;139(12):e214405. doi:10.1001/jamaophthalmol.2021.4405
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