+44 7480725689G. Subash P. Govindasamy
Consultant Ophthalmologist, Armed Forces Hospital Lumut, Malaysia
ScientificTracks Abstracts: Neurosci
Sinonasal undifferentiated carcinoma (SNUC) is an extremely aggressive malignancy. Extension to the orbit and adjacent structures is common, but isolated visual loss as a presenting symptom is rare. We report a rare case of SNUC with bilateral visual loss as the initial manifestation. A 34-year-old gentleman presented with acute onset loss of vision in both eyes for one week. It was followed by recurrent headaches and epistaxis. Visual acuity in the right eye was 2/60 and 3/60 in the left eye. Funduscopy showed a bilateral swollen disc. Neuroimaging revealed a large mass in the ethmoidal sinus extended laterally causing compression to recti muscles and the optic nerves. The histopathological examination of nasal tissue biopsy showed features of SNUC with bone and perineural invasion. A diagnosis of SNUC with bilateral compressive optic neuropathy was established. The patient underwent successful combined endoscopic and transcranial excision of the tumor. Debulking of the tumor was performed via bicoronal craniectomy with the base of skull reconstruction by the neurosurgical team. Postoperatively, funduscopy showed resolving optic disc swelling in both eyes; vision improved to 6/9 in the right eye only. He was started on chemotherapy. During third cycle, he had vision loss in right eye. CT scan showed recurrence invading intraconal space bilaterally and compressing the optic nerves. He underwent intensity-modulated radiation therapy (IMRT) of the fasciocervical region for seven weeks and weekly intravenous cisplatin injection. However, his both eyes became blind with no light perception during treatment. Unfortunately he succumbed to Covid ��? 19 infection recently. In conclusion, SNUC is a highly aggressive tumor that may present with acute blindness. Early treatment may save a life, but the visual prognosis is guarded due to extensive optic nerve damage caused by tumor compression.
G.Subash P.Govindasamy has completed his MBBS at the age of 27 years from Thanjavur Medical College , Bharathidasan University, India and Masters in Ophthalmology from University Malaya, Malaysia. He has 21 years of experience in the field of Comprehensive Ophthalmology. He is the Head of Ophthalmological Services in Ministry of Defence Malaysia health services. He is also an active member of the Rotary District 3300 Action Group on Blindness Prevention.
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