Localized bi-nasal macular edema in optic chiasmal syndrome
A 28-year-old healthy male was seen in our clinic complaining of vision loss in his right eye (OD). Best-corrected visual acuity (BCVA) was OD: 20/200 and left eye (OS): 20/20. Anterior segment examination revealed a relative afferent pupillary defect in the OD. Fundus examination disclosed localized bilateral temporal pallor in the optic nerve. The rest of the ophthalmologic examination was found to be within normal limits. Fundus pictures and fluorescein angiogram (FA) were performed during the first visit. Mild vascular abnormalities were detected in the temporal aspect of right optic nerve, but no conclusive information was obtained. The OS was deemed to be normal. OCT using the Stratus OCT 3 model (Carl Zeiss Meditec, Jena, Germany) was indicated for the evaluation of the macular areas, RNFL thicknesses, and optic nerves. The fast macular protocol revealed subtle macular thickness beyond normal in the superior and nasal quadrants of both maculae. No visible alterations in the internal microarchitecture of the retina were observed using several retinal lines and optic disc protocols. The RNFL thickness was near the superior normal limit in OD. A slight incremental thickening of the RNFL was observed in the superior and nasal quadrants of the OS.\nIn order to evaluate the patient's visual field (VF) and retinal sensitivities, a frequency doubling technology perimetry (FDT), using the commercially available (Matrix®) device, was performed in both eyes. The threshold 30-2 strategy revealed the presence of junctional scotoma composed by a central scotoma in OD associated with superior temporal quadrantanopia in the fellow eye. The pattern detected in the VF suggested the presence of an expansive mass at the level of the optic chiasm []. Magnetic resonance imaging (MRI) was performed which disclosed the presence of a tumor, compatible with the diagnosis of pituitary adenoma []. After a complete neurological evaluation, medical treatment with Cabergoline (a dopamine agonist), once a week, was recommended. After 8 months, a significant reduction of tumor volume was achieved. Moreover, the patient experienced a full recovery of BCVA and VF []. Functional normalization was accompanied with restoration of macular thickness.