A 14-year-old girl reported experiencing blurred vision beginning 2 months and 1 month ago in the left and right eye, respectively. She was examined at two local hospitals before she was referred to us under the impression of optic neuropathy. Her corrected visual acuity was 2/60 in the right eye and light perception only in the left. She could identify one plate in the right eye and zero plate in the left eye with the Ishihara color test. Anterior segment was normal OU. Fundoscopic examination revealed optic atrophy in both eyes (Fig. 44.1). Peripapillary nerve fibers and macular ganglion cell complexes were near totally lost in both eyes. Central scotoma with peripheral constriction was noted in the right eye, while the visual field in the left eye was totally lost (Fig. 44.2). An MRI showed a suprasellar lesion with a cystic component that was heterogeneously enhanced (Fig. 44.3). The patient underwent a craniotomy for the removal of the suprasellar tumor 1 week later. The pathologic report indicated germinoma. Peripheral blood testing for AFP, beta HCG, and ACTH was normal. She received extended focal radiation of 44 Gy. In addition, cortisol and thyroxine were given as postsurgical replacement treatments. Two months later, her vision recovered to 6/60 in the right eye, but the left vision remained as light perception.
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