Purpose: We report the case of a patient with severe optic disc edema secondary to prostate cancer, a relatively rare condition in Japan, who responded to hormone therapy.
Case: A 73-year-old man was referred to our hospital after he presented to a nearby hospital with a black line shadow in his left eye visual field and was diagnosed with bilateral severe optic disc edema. Visual acuity at first visit was 1.2 (right eye) and 1.0 (left eye). Fundus examination revealed severe bilateral optic disc edema, retinal hemorrhages, cotton-wool exduate in the peripapillary area, and retinal fold in the macula. Optical coherence tomography revealed bilateral optic disc elevation and serous retinal detachment in the macula. Goldmann perimeter test showed Mariotte blind spot enlargement and some scattered scotoma. A lumbar puncture revealed high intracranial pressure and magnetic resonance imaging did not reveal space-occupying lesions inside the cranium. Idiopathic intracranial hypertension was consequently suspected and oral administration of acetazolamide (750 mg/day) was started. However, the administration of this drug did not sufficiently ameliorate the high intracranial pressure and optic disc edema, and the left corrected visual acuity decreased to 0.2. The patient was subsequently hospitalized for further examination. The additional blood test showed an elevation of prostate specific antigen. A prostate biopsy revealed adenocarcinoma; however, the result of examining cerebrospinal fluid cytology for three times was negative for malignant cells. After endocrine therapy, the intracranial pressure and the value of prostate specific antigen were normalized, the optic disc edema and serous retinal detachment were dissolved 90 days after starting treatment, and visual acuity was improved to 1.0 in the right eye and 0.8 in the left eye.
Conclusions: Persistent papilledema leads to optic nerve degeneration. Hormone therapy was effective for maintaining visual acuity in the present case.