Radiation retinopathy after fractionated stereotactic radiotherapy for optic nerve sheath meningioma

PURPOSE: To report a patient with radiation retinopathy after fractionated stereotactic radiotherapy for treatment of optic nerve sheath meningioma (ONSM). DESIGN: Interventional case report. METHODS: The clinical presentation, radiation treatment, and subsequent visual complications of a patient with ONSM are described. MAIN OUTCOME MEASURES: Development of radiation retinopathy and Snellen visual acuity. RESULTS: A 36-year-old man presented with a left optic neuropathy. Magnetic resonance imaging studies showed abnormalities consistent with ONSM. Because of progressive vision loss, the patient underwent fractionated stereotactic radiotherapy for the lesion. Vision initially improved after treatment, but 22 months later, retinal abnormalities consistent with radiation retinopathy were noted in the left eye. Visual acuity worsened over the next 24 months in association with the development of retinal hemorrhages, lipid, and retinal edema predominantly within the nasal portion of the posterior pole. Fluorescein angiography showed edema associated with microaneurysms, retinal telangiectasia, and capillary nonperfusion. Laser photocoagulation was performed on several occasions in areas of microaneurysms and retinal telangiectasia; however, the retinal edema and lipid remained, associated with persistent decreased vision. CONCLUSIONS: Radiation retinopathy and vision loss may occur after fractionated stereotactic radiotherapy for ONSM and should be discussed as a potential complication.