Loss of myelinated retinal nerve fibers from chronic papilledema.

An intracranial pilocytic astrocytoma was diagnosed in a 13-year-old boy after he presented with headaches and visual disturbances. The initial ophthalmoscopic examination revealed papilledema bilaterally and myelinated retinal nerve fibers (MRNFs) in the left eye. Serial ophthalmoscopic examinations demonstrated gradual fading of the MRNFs beginning 2 months after tumor resection and their complete disappearance by 2 years after surgery. The disappearance of MRNFs has been described in the presence of ischemia, compression, glaucoma, and demyelinating disease of the optic nerve. This patient demonstrates that loss of myelinated nerves fibers may also occur with the optic atrophy that may follow chronic papilledema.