1
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Ball JE, Smith BM, Zocchi K, Doyle J. Clinical, electrophysiologic and serologic evidence of cancer associated retinopathy preceding a diagnosis of breast cancer. BMJ Case Rep 2024; 17:e257911. [PMID: 38670565 PMCID: PMC11057256 DOI: 10.1136/bcr-2023-257911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024] Open
Abstract
We report the case of a woman in her 50s who presented headaches, blurred vision, diplopia and loss of peripheral vision. She was treated for normal tension glaucoma based on optic nerve cupping prior to the development of diplopia. Records demonstrated visual field constriction over 4 months despite well-controlled intraocular pressures. Examination revealed decreased visual acuity and visual field constriction. The multifocal electroretinogram was abnormal. After a thorough review of her medical and family history, a concern for cancer-associated retinopathy developed. Blood samples were positive for antiretinal antibodies against 23 kDA and 46 kDA proteins. Cancer screening was recommended as the aetiology for retinopathy was unknown and revealed a left breast lump. Following lumpectomy with adjuvant chemoradiation, her visual acuity normalised and visual field defects completely resolved. This case serves to provide an example that distant systemic symptoms may be a manifestation of the underlying malignancy and the importance of clinical suspicion with prompt evaluation.
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Affiliation(s)
- Jordan E Ball
- Ophthalmology, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA
- Vitreoretinal Surgery, Retina Associates, Little Rock, Arkansas, USA
| | - Brian M Smith
- Ophthalmology, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA
| | - Kent Zocchi
- Vitreoretinal Surgery, Retina Associates, Little Rock, Arkansas, USA
| | - Jennifer Doyle
- Neuro-Ophthalmology, Little Rock Eye Clinic, Little Rock, Arkansas, USA
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2
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Gougoulakis LS, Rothermundt C, Flynn MC, Jörger M, Todorova MG. Electrodiagnostic Biomarkers in Paraneoplastic Retinopathy. Klin Monbl Augenheilkd 2024; 241:510-524. [PMID: 38653300 DOI: 10.1055/a-2227-3970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
OBJECTIVE Paraneoplastic retinopathy (PNR) is a rapid-onset photoreceptor and post-photoreceptor dysfunction triggered by a cross-reaction between antigens expressed by the underlying tumour and retinal proteins. The present study aims to determine the electrodiagnostic biomarkers that support the diagnosis of PNR and evaluate the effect of treatment. METHODS A retrospective observational case-controlled study including 25 patients with suspected PNR, of which 11 patients were diagnosed with PNR. The presence of PNR was confirmed based on clinical examination, supported by colour fundus photography, fundus autofluorescence imaging, optical coherence tomography, fluorescein angiography, retinal vessel oximetry, colour test, full-field electroretinogram (ffERG), on-/off ERG, S-cone ERG, and multifocal ERG (mfERG). The relationships between the clinical symptomatology and the effect of therapy were evaluated. RESULTS All PNR patients (Nr: 11) presented with subjective symptoms of newly reported central vision or visual field deterioration. Posterior segment findings showed a severe patchy-like retinal atrophy, attenuation of the retinal vessels, and a waxy optic disc. Optical coherence tomography revealed a discontinued ISe line, and multiple hyperreflective foci. Retinal vessel oxygen saturation was increased. Multifocal ERG revealed reduced central and paracentral responses and ffERG severely attenuated scotopic-, photopic-, on-/off- and S-cone responses. The colour vision test revealed a tritan-tetartan-weakness. Two of the PNR patients underwent rituximab therapy with no further progression and even recovery of electrodiagnostic responses.In 1 nPNR (non-paraneoplastic retinopathy) patient (total Nr: 14) pseudoxanthoma elasticum-related retinopathy was the reason for impaired vision. In 3 of 13 patients with bronchopulmonary cancer a MEK- and FGFR-inhibitor- drug toxicity was the reason for the visual deterioration. CONCLUSION Careful investigation for signs of central and/or peripheral visual field deterioration must be performed in the presence of history of a co-existing malignancy. The possibility of PNR should be taken into account. The electrodiagnostic biomarkers, suggested in this study, may help to promptly recognise PNR and also to evaluate the effect of implemented therapy.
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Affiliation(s)
| | - Christian Rothermundt
- Clinic of Medical Oncology and Haematology, Cantonal Hospital St. Gallen, Switzerland
| | - Marie-Claire Flynn
- Clinic of Medical Oncology and Haematology, Cantonal Hospital St. Gallen, Switzerland
| | - Markus Jörger
- Clinic of Medical Oncology and Haematology, Cantonal Hospital St. Gallen, Switzerland
| | - Margarita G Todorova
- Department of Ophthalmology, Cantonal Hospital St. Gallen, Switzerland
- Department of Ophthalmology, University of Zürich, Switzerland
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Tajfirouz D, Chen JJ. Paraneoplastic vision loss. Handb Clin Neurol 2024; 200:203-210. [PMID: 38494278 DOI: 10.1016/b978-0-12-823912-4.00003-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Paraneoplastic vision loss, which represents a small percentage of paraneoplastic neurologic syndromes, can be a blinding disease. Presenting visual symptoms are variable, making diagnosis challenging. History of the presenting illness, ocular examination, and utilization of various modalities, such as automated perimetry, ocular coherence tomography, and electroretinogram allow for localization of vision loss to the optic nerves or retina, guiding in diagnosis and management. Paraneoplastic vision loss is often painless, bilateral, and subacute, and accompanies other neurologic symptoms but can be the first presenting symptom. Paraneoplastic optic neuropathy has been described in association with several antibodies, but most commonly anti-CRMP5. Cancer-associated retinopathy is the most common paraneoplastic autoimmune retinopathy; however, melanoma-associated retinopathy and bilateral diffuse uveal melanocytic proliferation have also been described to be associated with a paraneoplastic process affecting the retina. Paraneoplastic visual loss is an expanding field and advances in research have improved phenotypic characterization; however, further work is needed to identify more reliable biomarkers of disease and to better understand the underlying mechanisms and management.
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Affiliation(s)
- Deena Tajfirouz
- Department of Ophthalmology, Mayo Clinic, Rochester, MN, United States; Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - John J Chen
- Department of Ophthalmology, Mayo Clinic, Rochester, MN, United States; Department of Neurology, Mayo Clinic, Rochester, MN, United States.
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Drača N, Orešković EG, Lazić R, Vukojević M, Radolović Bertetić A, Vukojević N. Management of Bilateral Diffuse Uveal Melanocytic Proliferation (BDUMP)-A Case Report. Medicina (Kaunas) 2023; 59:2158. [PMID: 38138261 PMCID: PMC10745080 DOI: 10.3390/medicina59122158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 11/27/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023]
Abstract
Background and Objectives: This study reports a case of a 62-year-old patient experiencing a significant decline in vision over the past three months. The initial best-corrected visual acuity (BCVA) of 20/20 in both eyes diminished to 20/200 in the right eye (RE) and counting fingers (CF) in the left eye (LE) within this timeframe. The patient was diagnosed with stage 4 ovarian cancer just one month before the significant vision deterioration. Materials and Methods: A thorough ophthalmologic examination revealed a notable progression of cataracts and the presence of subretinal fluid on the posterior pole, accompanied by choroidal thickening. The right eye exhibited multifocal, orange-pigmented, and elevated choroidal lesions, while the left eye's fundus examination was impeded by dense cataracts. Optical coherence tomography (OCT) revealed bilateral choroidal thickening with overlying folds and subretinal fluid, and ultrasound imaging of the choroidal lesions indicated moderate homogenous internal reflectivity. Results: The patient received a diagnosis of BDUMP (bilateral diffuse uveal melanocytic proliferation), a paraneoplastic syndrome marked by simultaneous, bilateral, painless vision loss and the rapid onset of bilateral cataracts with serous retinal detachments. Despite cataract extraction, the expected visual recovery was not achieved (RE: CF; LE: 2/200, respectively). Plasmapheresis showed some success in stabilizing vision loss attributed to serous retinal detachments. Conclusions: BDUMP necessitates addressing the underlying malignancy for effective treatment. Left untreated, it can lead to near blindness within a year. The prognosis remains grim, with an average survival time ranging from 12 to 15.7 months from the time of diagnosis. Considering this case report, it is crucial to establish effective management plans and further investigate potential treatment methods and predictive markers centered around BDUMP. Collaboration between healthcare professionals and researchers is crucial in addressing the complexities of BDUMP, as the timely diagnosis and treatment of the disease remains a top priority.
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Affiliation(s)
- Nataša Drača
- Svjetlost Eye Clinic and University Hospital, 10000 Zagreb, Croatia; (E.G.O.); (R.L.)
| | - Emma Grace Orešković
- Svjetlost Eye Clinic and University Hospital, 10000 Zagreb, Croatia; (E.G.O.); (R.L.)
| | - Ratimir Lazić
- Svjetlost Eye Clinic and University Hospital, 10000 Zagreb, Croatia; (E.G.O.); (R.L.)
| | - Marija Vukojević
- Department of Ophthalmology, General Hospital Pula, 52100 Pula, Croatia;
- Institute of Emergency Medicine of Sisak-Moslavina County, 44000 Sisak, Croatia
| | | | - Nenad Vukojević
- Department of Opthalmology, University Hospital Rebro, 10000 Zagreb, Croatia; (A.R.B.); (N.V.)
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Brossard-Barbosa N, Dezard V, Margolin E. Treatment of Cancer-Associated Retinopathy: A Systematic Literature Review. Ophthalmol Retina 2023; 7:819-828. [PMID: 37160190 DOI: 10.1016/j.oret.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 05/01/2023] [Accepted: 05/02/2023] [Indexed: 05/11/2023]
Abstract
TOPIC Systematic literature review of treatment efficacy of previously used protocols in treating patients with proven cancer-associated retinopathy (CAR). CLINICAL RELEVANCE There is no universally accepted treatment algorithm for CAR and visual prognosis is very poor. We describe a patient with CAR with dramatic improvement in vision after treatment with high doses of corticosteroids followed by plasma exchange (PLEX) and present results of a systematic literature review of treatment efficacy of previously used protocols in treating patients with proven CAR. METHODS We describe a 70-year-old man with CAR who demonstrated dramatic improvement in vision after treatment with high doses of systemic corticosteroids followed by 7 sessions of PLEX. We then report the results of a systematic review of all previously published English literature discussing visual outcomes of various treatment regimens used for patients with antibody-proven CAR. RESULTS The index patient is a rare case of CAR with sustained significant improvement in vision after treatment with high doses of corticosteroids followed by PLEX. The systematic review identified 28 antibody-proven cases of CAR, 27 of which were treated with steroids, which resulted in varying degrees of improvement in visual acuity in 59% (16 of 27). The time from symptom onset to initiation of treatment and the dose of steroids did not influence the visual outcome. Three patients were also treated with PLEX in addition to steroids, and 2 of 3 patients demonstrated improvement in vision; however, there was no difference in visual outcome in patients treated with steroids only versus those treated with steroids + PLEX. CONCLUSION Treatment with steroids or steroids + PLEX resulted in some improvements in visual acuity in 59% of patients. Removal of antirecoverin antibodies with PLEX can arrest the immune attack on the photoreceptors and potentially improve visual function; thus, it should be considered in addition to steroids. Further studies with larger cohorts are needed to establish a treatment protocol and further determine the effectiveness of the different approaches. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Natalie Brossard-Barbosa
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Victoria Dezard
- University of Toronto, Department of Human Biology, Toronto, Ontario, Canada
| | - Edward Margolin
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada; Faculty of Medicine, Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada.
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Zhao F, Hu L, Guo R, Li Z, Ji J, Liu W. Bilateral Diffuse Uveal Melanocytic Proliferation Initially Presented as Glaucoma. Ocul Immunol Inflamm 2023; 31:601-608. [PMID: 35201969 DOI: 10.1080/09273948.2022.2032201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 12/31/2021] [Accepted: 01/15/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE To report a bilateral diffuse uveal melanocytic proliferation (BDUMP) patient whose initial presentation was glaucoma. METHODS Clinical review of a BDUMP case. RESULTS A 65-year-old woman presented with ocular pain of the left eye for 1 day and vision loss of the right eye for 1 week. An ophthalmological examination revealed increased intraocularr pressure in the left eye and shallow anterior chamber in both eyes. BDUMP was diagnosed following a series of auxiliary examinations. After 1.5 years of follow-up, progressive cataracts appeared, and the patient accepted cataract surgery in both eyes. Visual acuity improved from light perception to 20/100 in both eyes 1.5 years after cataract surgery, but declined to light perception again at the last follow-up. CONCLUSION BDUMP can be initially presented as glaucoma, and cataract surgery can be considered in BDUMP patients in order to improve the patients' quality of life, even if exudative retinal detachment exists.
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Affiliation(s)
- Fangyu Zhao
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Liying Hu
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Ruru Guo
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Zhiqing Li
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Jian Ji
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Wei Liu
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
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Ng CC, Alsberge JB, Qian Y, Freund KB, Cunningham ET. VOGT-KOYANAGI-HARADA-LIKE UVEITIS FOLLOWED BY MELANOMA-ASSOCIATED RETINOPATHY WITH FOCAL CHORIORETINAL ATROPHY AND CHOROIDAL NEOVASCULARIZATION IN A PATIENT WITH METASTATIC CUTANEOUS MELANOMA. Retin Cases Brief Rep 2023; 17:18-22. [PMID: 33394953 PMCID: PMC9750092 DOI: 10.1097/icb.0000000000001113] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
PURPOSE To report a case of Vogt-Koyanagi-Harada-like uveitis followed by melanoma-associated retinopathy with focal chorioretinal atrophy and subsequent choroidal neovascularization in a patient with metastatic cutaneous melanoma. METHOD Case report. Main outcome measures include external photography, anterior segment photography, ophthalmoscopic examination, fundus photography, fluorescein angiography, indocyanine green angiography, spectral domain optical coherence tomography, optical coherence tomography angiography, and electroretinography. RESULTS A 68-year-old man with a history cutaneous melanoma presented with Vogt-Koyanagi-Harada-like uveitis. Work-up revealed a pelvic mass, which was excised and found to be metastatic melanoma. Two years later, the patient developed melanoma-associated retinopathy with focal chorioretinal atrophy and adjacent choroidal neovascularization. CONCLUSION Patients with metastatic cutaneous melanoma can develop distinct and sequential paraneoplastic ocular complications. Onset of a Vogt-Koyanagi-Harada-like uveitis may be a good prognostic factor for survival in patients with metastatic cutaneous melanoma.
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Affiliation(s)
- Caleb C. Ng
- West Coast Retina Medical Group, San Francisco, California
- The Department of Ophthalmology, California Pacific Medical Center, San Francisco, California, USA. Dr. Alsberge is now with The Department of Ophthalmology, Northwest Permanente, Portland, Oregon
| | - Joseph B. Alsberge
- West Coast Retina Medical Group, San Francisco, California
- The Department of Ophthalmology, California Pacific Medical Center, San Francisco, California, USA. Dr. Alsberge is now with The Department of Ophthalmology, Northwest Permanente, Portland, Oregon
| | - Ying Qian
- The Department of Ophthalmology, Kaiser Permanente, Oakland, California
| | - K. Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, New York
- NYU Grossman School of Medicine, New York, New York
| | - Emmett T. Cunningham
- West Coast Retina Medical Group, San Francisco, California
- The Department of Ophthalmology, California Pacific Medical Center, San Francisco, California, USA. Dr. Alsberge is now with The Department of Ophthalmology, Northwest Permanente, Portland, Oregon
- The Department of Ophthalmology, Stanford University School of Medicine, Stanford, California; and
- The Francis I. Proctor Foundation, UCSF School of Medicine, San Francisco, California
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8
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Parrado-Carrillo A, Alcubierre R, Camós-Carreras A, Sanchez-Dalmau BF. Paraneoplastic syndromes in ophthalmology. Arch Soc Esp Oftalmol (Engl Ed) 2022; 97:350-357. [PMID: 35292226 DOI: 10.1016/j.oftale.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 08/03/2021] [Indexed: 06/14/2023]
Abstract
Paraneoplastic syndromes consist on systemic manifestations associated with certain cancers which are not a direct consequence of tumor invasion or its metastases. It is known that autoimmunity and autoantibody synthesis play an important role in its pathophysiology due to a process of molecular mimicry. Paraneoplastic syndromes in ophthalmology are rare, but it is important to recognize them clinically because in some cases symptoms preceded the diagnosis of an underlying neoplasia. Most frequently involved cancer is small cell lung carcinoma, but there is also a relationship with other tumor etiologies such as thymoma, gynecological tumors or neuroblastoma in children. Paraneoplastic syndromes with ocular involvement can be divided into those that affect the afferent visual pathway, such as cancer-associated retinopathy, melanoma-associated retinopathy, or paraneoplastic optic neuropathy; and the ones that affect the efferent visual pathway, such as bilateral tonic pupils, Myasthenia Gravis, Lambert-Eaton syndrome or paraneoplastic cerebellar degeneration. The presence of autoantibodies is helpful in clinical practice but negativity does not exclude this diagnosis. Although evolution and prognosis is linked to primary disease, in some cases specific treatment, usually immunosuppressive therapy, can help improving patients quality of life.
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Affiliation(s)
- A Parrado-Carrillo
- Institut Clínic d'Oftalmologia (ICOF), Hospital Clínic, Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.
| | - R Alcubierre
- Complex Hospitalari Moisès Broggi, Consorci Sanitari Integral, Sant Joan Despí, Barcelona, Spain
| | - A Camós-Carreras
- Institut Clínic d'Oftalmologia (ICOF), Hospital Clínic, Barcelona, Spain
| | - B F Sanchez-Dalmau
- Institut Clínic d'Oftalmologia (ICOF), Hospital Clínic, Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
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9
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Bentata R, Chan H, Coste V, Delyfer MN, Ducassou S, Léger F, Korobelnik JF. [Pseudo-hypopyon secondary to a meningeal recurrence of acute lymphoblastic leukemia: Case report]. J Fr Ophtalmol 2020; 43:e259-e261. [PMID: 32800420 DOI: 10.1016/j.jfo.2020.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 12/22/2019] [Accepted: 01/03/2020] [Indexed: 11/18/2022]
Affiliation(s)
- R Bentata
- Service d'ophtalmologie, CHU Pellegrin, place Amélie-Raba-Léon, 33000 Bordeaux, France; Université de Bordeaux, rue Léo-Saignat, 33000 Bordeaux, France.
| | - H Chan
- Service d'ophtalmologie, CHU Pellegrin, place Amélie-Raba-Léon, 33000 Bordeaux, France; Université de Bordeaux, rue Léo-Saignat, 33000 Bordeaux, France
| | - V Coste
- Service d'ophtalmologie, CHU Pellegrin, place Amélie-Raba-Léon, 33000 Bordeaux, France; Université de Bordeaux, rue Léo-Saignat, 33000 Bordeaux, France
| | - M-N Delyfer
- Service d'ophtalmologie, CHU Pellegrin, place Amélie-Raba-Léon, 33000 Bordeaux, France; Université de Bordeaux, rue Léo-Saignat, 33000 Bordeaux, France
| | - S Ducassou
- Université de Bordeaux, rue Léo-Saignat, 33000 Bordeaux, France; Service d'onco-hématologie pédiatrique, CHU Pellegrin, Bordeaux, France
| | - F Léger
- Université de Bordeaux, rue Léo-Saignat, 33000 Bordeaux, France; Service d'anatomopathologie, CHU Pellegrin, Bordeaux, France
| | - J-F Korobelnik
- Service d'ophtalmologie, CHU Pellegrin, place Amélie-Raba-Léon, 33000 Bordeaux, France; Université de Bordeaux, rue Léo-Saignat, 33000 Bordeaux, France
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10
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Rhizlane A, Lakrimi S, Afkir S, Oujidi W, Siham C, Maadan A, Sekhsoukh R. [Bilateral central retinal vein occlusion as presenting sign of lung cancer]. J Fr Ophtalmol 2020; 43:805-808. [PMID: 32773229 DOI: 10.1016/j.jfo.2019.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 12/13/2019] [Accepted: 12/20/2019] [Indexed: 11/18/2022]
Affiliation(s)
- A Rhizlane
- CHU Med VI Oujda Maroc, résidence Kenzi II R21 0 D Hay El Andalouss, 60000 Oujda, Maroc.
| | - S Lakrimi
- CHU Med VI Oujda Maroc, résidence Kenzi II R21 0 D Hay El Andalouss, 60000 Oujda, Maroc
| | - S Afkir
- CHU Med VI Oujda Maroc, résidence Kenzi II R21 0 D Hay El Andalouss, 60000 Oujda, Maroc
| | - W Oujidi
- CHU Med VI Oujda Maroc, résidence Kenzi II R21 0 D Hay El Andalouss, 60000 Oujda, Maroc
| | - C Siham
- CHU Med VI Oujda Maroc, résidence Kenzi II R21 0 D Hay El Andalouss, 60000 Oujda, Maroc
| | - A Maadan
- CHU Med VI Oujda Maroc, résidence Kenzi II R21 0 D Hay El Andalouss, 60000 Oujda, Maroc
| | - R Sekhsoukh
- CHU Med VI Oujda Maroc, résidence Kenzi II R21 0 D Hay El Andalouss, 60000 Oujda, Maroc
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Abstract
Melanoma-associated retinopathy (MAR) is a rare paraneoplastic autoimmune manifestation of cutaneous malignant melanoma. Patients classically present with acute onset night blindness, positive visual phenomena and visual field defects, and typically have significantly reduced quality of life as a result. Early recognition of MAR is of prognostic significance as it can precede the diagnosis of primary or metastatic malignant melanoma, and early treatment can lower the risk of irreversible immunological damage to the retinal cells with improved visual outcomes. The focus of our review article is therefore to raise awareness of MAR and present the latest evidence relating to the investigation and management of this condition.
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Affiliation(s)
- S Elsheikh
- Birmingham Neuro-Ophthalmology, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, UK
| | - S P Gurney
- Birmingham Neuro-Ophthalmology, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, UK
| | - M A Burdon
- Birmingham Neuro-Ophthalmology, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, UK
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12
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Abstract
PURPOSE OF REVIEW This article discusses the varied types of paraneoplastic syndromes that commonly have neuro-ophthalmologic manifestations. Diagnostic considerations and therapeutic options for individual diseases are also discussed. RECENT FINDINGS Paraneoplastic syndromes can affect the afferent and efferent visual systems. Paraneoplastic syndromes may result in reduced visual acuity from retinal degeneration, alterations in melanocyte proliferation and uveal thickening, or acquired nystagmus. Ocular motor abnormalities related to paraneoplastic syndromes may present with symptoms from opsoclonus or from neuromuscular junction disease. Diagnosis remains challenging, but serologic identification of some specific antibodies may be helpful or confirmatory. Treatment, in addition to directed therapies against the underlying cancer, often requires systemic corticosteroids, plasma exchange, or immunosuppression, but some specific syndromes improve with use of targeted pharmacologic therapy. SUMMARY Diagnosis and therapy of paraneoplastic syndromes presenting with neuro-ophthalmic symptoms remain a challenge, but strategies are evolving and new approaches are on the horizon.
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13
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Abstract
Pituitary adenomas can manifest as ophthalmological symptoms, such as decreased vision, impaired visual field or diplopia. It is important to recognize these neuro-ophthalmological syndromes to achieve early diagnosis and treatment and to improve prognosis. Currently, ophthalmological examination includes precise measuring instruments, such as optical coherence tomography (OCT), which allows the evaluation of optic atrophy related to compression of the anterior optic tract. These measurements are reproducible and are useful for diagnostic and prognostic evaluation. In this review, we describe the ophthalmological syndromes associated with pituitary tumours: anterior optic pathway compression, followed by oculomotor disorders and pituitary apoplexy.
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Affiliation(s)
- Anne-Laure Vié
- Neuro-ophthalmologist Service, Pierre Wertheimer Hospital, 59 Boulevard Pinel, 69677, Bron, France.
| | - Gérald Raverot
- Endocrinology Federation Louis Pradel Hospital, 59 Boulevard Pinel, 69677, Bron, France.
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14
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Affiliation(s)
- Lucia Sobrin
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts.
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15
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Nivean M, Muttuvelu DV, Afzelius P, Berman DC. Paraneoplastic retinopathy associated with occult bladder cancer. Indian J Ophthalmol 2016; 64:248-50. [PMID: 27146943 PMCID: PMC4869471 DOI: 10.4103/0301-4738.181744] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Accepted: 01/12/2016] [Indexed: 11/18/2022] Open
Abstract
The aim was to report the first case of cancer-associated retinopathy (CAR) presenting before bladder cancer diagnosis. A 71-year-old woman with a history of bilateral vision loss underwent subsequent complete ophthalmic examination include a fluorescein angiography, full-field electroretinogram (ERG), serology including serum antibodies for CAR, and positron emission tomography-computed tomography (PET-CT) scan. The patient was diagnosed with bladder carcinoma revealed by PET-CT. Timely recognition of this entity may be crucial for an increased patient survival thus adult onset progressive photoreceptor dysfunction, confirmed by ERG, should alert to a possible remote effect of known or occult malignancy. In the latter, PET-CT may be exploited as a powerful diagnostic tool.
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Affiliation(s)
- M Nivean
- Department of Ophthalmology, M N Eye Hospital, Chennai, Tamil Nadu, India
| | - Danson V Muttuvelu
- Department of Ophthalmology, Aalborg University Hospital, Aalborg, Denmark
| | - Pia Afzelius
- Department of Nuclear Medicine, Aalborg University Hospital, Aalborg, Hillerød, Denmark
- Department of Diagnostic Imaging, North Zealand Hospital, Hillerød, Denmark
| | - Dalia C Berman
- Department of Ophthalmology, Aalborg University Hospital, Aalborg, Denmark
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16
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Schalenbourg A, Mantel I. [The eye and cancer]. Rev Med Suisse 2015; 11:2395-2398. [PMID: 26852556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Cancer involves so rarely the eye that it may be recognized late. The most frequent primary intra-ocular tumours are retinoblastoma in small children and uveal melanoma in adults. Vision loss in systemic cancer has a varied differential diagnosis. Uveal metastases are most often associated with breast cancer, but can herald lung carcinoma. Masquerade syndrome looks like inflammation but represents the ocular involvement of primary CNS non-Hodgkin lymphoma. Systemic cancer drugs, as well as radiotherapy, can cause ocular toxicity, mostly at the retina. In the rare paraneoplastic syndromes, patient's cancer antibodies cross-react with retinal antigens, leading to severe vision loss. When cancer involves the eye, a fast referral into specialized care can significantly improve visual and vital prognosis.
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Patel A, Aslam A, Orr G, Perkins W. Lesson of the month 1: Seeing snowflakes. Clin Med (Lond) 2015; 15:394-5. [PMID: 26407395 PMCID: PMC4952808 DOI: 10.7861/clinmedicine.15-4-394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Melanoma-associated retinopathy is a rare paraneoplastic complication of metastatic cutaneous malignant melanoma. It may present years after the original diagnosis of melanoma. We describe a patient with this condition who presented with persistent visual symptoms.
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Affiliation(s)
- Anand Patel
- consultant dermatologist and dermatological surgeon, Department of Dermatology, Nottingham NHS Treatment Centre, Nottingham, UK
| | - Arif Aslam
- post-CCT fellow in Mohs micrographic surgery, Department of Dermatology, Nottingham NHS Treatment Centre, Nottingham, UK
| | - Gavin Orr
- consultant ophthalmologist, Department of Ophthalmology, Queen's Medical Centre, Nottingham, UK
| | - William Perkins
- consultant dermatologist and dermatological surgeon, Department of Dermatology, Nottingham NHS Treatment Centre, Nottingham, UK
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18
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Bhavsar KV, Hedges T, Thirkill CE, Reichel E. Paraneoplastic retinopathy associated with systemic follicular cell lymphoma. Ophthalmic Surg Lasers Imaging Retina 2015; 46:373-6. [PMID: 25835308 DOI: 10.3928/23258160-20150323-13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 10/21/2014] [Indexed: 11/20/2022]
Abstract
The authors describe two rare cases of autoimmune retinopathy associated with follicular cell lymphoma, including a 54-year-old man who experienced nyctalopia for 1 year (patient 1) and a 59-year-old man who had bilateral loss of central vision for 6 months (patient 2). Visual field testing of patient 1 revealed nonspecific defects, and multifocal electroretinogram (ERG) testing showed mildly subnormal amplitudes more pronounced in the left than the right eye. Serologic testing detected antibodies against a 47-kD protein, presumed to be alpha-enolase. Goldmann perimetry of patient 2 showed dense central scotomas, and a full-field ERG revealed reduced amplitudes of bright scotopic responses. Serological testing yielded anti-bipolar cell antibodies. A variable presentation of autoimmune retinopathy can occur in the setting of follicular cell lymphoma. Disparate serum autoantibodies may have mediated the pathogenesis of retinal degeneration in these two patients and could explain the difference in course and severity of retinopathy.
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Huang HB, Wei SH, Li Y, Wang FX, Yao Y, Jiang CH, Yin ZQ, Zhang MN, Wei WB. [Clinical characteristics of paraneoplastic retinopathy and optic neuropathy]. Zhonghua Yan Ke Za Zhi 2013; 49:507-513. [PMID: 24119963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To analyze the clinical characteristics of paraneoplastic retinopathy and optic neuropathy(PRON). METHODS Case series study. Eight patients were enrolled from October 2006 to March 2012 visited in ophthalmology department, the People Liberation Army General Hospital. The patients were underwent a series of examinations, including fundus photography, visual electrophysiology, fundus fluorescein angiography, optic coherent tomography,fundus autofluorescent imaging, perimetry, ultrasonography, magnetic resonance imaging, spinal tap and cerebrospinal fluid test, paraneoplastic syndrome (PNS) antibody test. The patients were followed up in outpatient department and(or) by phone. The clinical manifestation,entity types, and treatment were analyzed. RESULTS Of the eight patients, there were cancer associated retinopathy(CAR) 3 cases, bilateral diffuse uveal melanocytic proliferation (BDUMP) 2 cases and paraneoplastic optic neuropathy(PON) 3 cases. Five patients were detected the PNS antibodies and revealed three patients with positive results. As for the primary malignancy,four of the eight patients were lung carcinoma,others included invasive thymoma, kidney cancer, acute lymphocytic leukemia and cervical cancer, each for one case. All the patients complained vision blurring or progressive visual decrease. Other complaints included dark shadow in two patients, shimmering, dazzling, double vision and eye pain, each in one patient. One patient complained progressive decreased vision in both eyes prior to the diagnosis of lung cancer. Of the 16 eyes of the eight patients, there were six patients with no light perception vision, five from light perception to 0.05, and other five with no less than 0.4 vision, in the end of the follow up. Five patients were treated with steroid with unsatisfactory efficacy. CONCLUSIONS Each entity of PRON has its own clinical characteristics. PRON especially BDUMP may be a pre-metastatic disease.
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Affiliation(s)
- Hou-bin Huang
- Department of Ophthalmology, the General Hospital of Chinese People Liberation Army,Beijing 100853,China
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Chéour M, Agrebi S, Hijazi A. Cancer associated retinopathy with periphlebitis and bilateral vitreous hemorrhage. Bull Soc Belge Ophtalmol 2013:71-76. [PMID: 24923085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Cancer associated retinopathy (CAR) is an uncommon paraneoplastic syndrome associated with epithelial neoplasm. Ocular symptoms of this syndrome are varied. CASE REPORT A 40-year-old man with an existing smoking history noticed a bilateral visual loss.Fundus examination showed a bilateral vitreous hemorrhage.In the left eye, there were narrowed retinal arterioles and peripapillary neovessels. An X-ray chest revealed a lung lesion which on biopsy proved to be a bronchial squamous cell carcinoma. After conducting several explorations,we have diagnosed CAR. CONCLUSION Vitreous hemorrhage is one of the symptoms of CAR. Thus, systems review, searching for an extraocular cancer, X-ray chest and ERG are recommended in this case.
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Monzon JG, Hammad N, Stevens SD, Dancey J. Retinopathy associated with adjuvant high-dose interferon-α2b in a patient with resected melanoma: a case report and review of the literature. Oncologist 2012; 17:384-7. [PMID: 22334452 DOI: 10.1634/theoncologist.2011-0324] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Interferon is the only accepted adjuvant treatment for patients with melanoma; hence, oncologists should be aware of the possibility of retinal abnormalities resulting from its use. Interferon-associated retinopathy in patients being treated for resected melanoma is a rare phenomenon with a proposed immunological basis. Patients are usually asymptomatic or have mild visual impairments, with cotton wool infarcts and hemorrhages. These symptoms and signs usually resolve with the discontinuation of interferon, but in a few severe presentations the visual impairments and retinal changes can be irreversible.
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Affiliation(s)
- Jose G Monzon
- NCIC Clinical Trials Group, Cancer Research Institute, Queen's University, 10 Stuart Street, Kingston, Ontario K7L 3N6, Canada.
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