Abstract
A 62-year-old female patient presented to our clinic complaining of a 2 month history of shimmering photopsias and floaters. An ocular examination, fluorescein angiography, and electrophysiological testing were obtained that suggested either an inflammatory retinal vasculitis or a paraneoplastic syndrome. Melanoma-associated retinopathy was highly suspected despite the absence of previous history for cutaneous melanoma since an electronegative scotopic ERG was recorded on standard flash electroretinography. Additional investigations revealed the presence of a primary breast tumor with secondary lung and pancreatic metastasis that led to the diagnosis of cancer-associated retinopathy. The patient received chemotherapy and 4 months after the initial presentation her visual complaints but also her retinal function showed marked improvement. Cancer-associated retinopathy needs to be considered in patients presenting with retinal vasculitis and electrophysiological testing can tailor the approach in these cases.
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References
Sawyer RA, Selhorst JB, Zimmerman LE, Hoyt WF (1976) Blindness caused by photoreceptor degeneration as a remote effect of cancer. Am J Ophthalmol 81:606–613
Khan N, Huang JJ, Foster CS (2006) Cancer associated retinopathy (CAR): an autoimmune-mediated paraneoplastic syndrome. Semin Ophthalmol 21:135–141
Maeda T, Maeda A, Maruyama I, Ogawa K, Kuroki Y, Sahara H, Sato N, Ohguro H (2001) Mechanisms of photoreceptor cell death in cancer-associated retinopathy. Invest Ophthalmol Vis Sci 42(3):705–712
Robertson DM (2002) Non-cancerous ophthalmic clues to non-ocular cancer. Surv Ophthalmol 47(5):397–430
Matsui Y, Mehta MC, Katsumi O, Brodie SE, Hirose T (1992) Electrophysiological findings in paraneoplastic retinopathy. Graefes Arch Clin Exp Ophthalmol 230:324–328
Audo I, Robson AG, Holder GE, Moore AT (2008) The negative ERG: clinical phenotypes and disease. Mechanisms of inner retinal dysfunction. Surv Ophthalmol 53:16–40
Koh AH, Hogg CR, Holder GE (2001) The incidence of negative ERG in clinical practice. Doc Ophthalmol 102:19–30
Lei B, Bush RA, Milam AH, Sieving PA (2000) Human melanoma-associated retinopathy (MAR) antibodies alter the retinal ON-response of the monkey ERG in vivo. Invest Ophthalmol Vis Sci 41:262–266
Alexander KA, Barnes CS, Fishman GA, Milam AH (2002) Nature of the cone on- pathway dysfunction in melanoma associated retinopathy. Invest Ophthalmol Vis Sc 43(4):1189–1197
Goetgebuer G, Kestelyn-Stevens AM, De Laey JJ, Kestelyn P, Leroy BP (2008) Cancer-associated retinopathy (CAR) with electronegative ERG: a case report. Doc Ophthalmol 116:49–55
Kim SJ, Toma HS, Thirkill CE, Dunn JP (2010) Cancer-associated retinopathy with retinal periphlebitis in a patient with ovarian cancer. Ocul Immunol Inflamm 18(2):107–109
Ing EB, Younge BR, Leavitt JA, Lee RA, Bostwick DG (1995) Paraneoplastic retinopathy and gynecologic malignancy. J Pelvic Surg 1:79–83
Rizzo JF, Gittinger JW (1992) Selective immunohistochemical staining in the paraneoplastic retinopathy syndrome. Ophthalmology 99:1286–1295
Cao R, Cao Y (2010) Cancer-associated retinopathy: a new mechanism insight on vascular remodeling. Cell Cycle 9(10):1882–1885
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We would like to acknowledge Mr Martin Lindeman for his contribution on the preparation of the artwork.
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Anastasakis, A., Dick, A.D., Damato, E.M. et al. Cancer-associated retinopathy presenting as retinal vasculitis with a negative ERG suggestive of on-bipolar cell pathway dysfunction. Doc Ophthalmol 123, 59–63 (2011). https://doi.org/10.1007/s10633-011-9277-y
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DOI: https://doi.org/10.1007/s10633-011-9277-y