Non-cancerous ophthalmic clues to non-ocular cancer

Cancer-associated retinopathy in ampullary pancreatic cancer

A 64-year-old woman presented with bilateral visual loss with shimmering photopsias as the only clinical manifestation of an occult pancreatic ampullary adenocarcinoma causing duct dilatation. Abnormal electroretinograms led to suspicion of cancer-associated retinopathy (CAR), and CT of the abdomen showed an underlying pancreatic malignancy, detected with subclinical liver function tests following diagnosis of CAR. Biopsy showed a T2N0M0 ampullary adenocarcinoma. The patient was managed with Whipple's procedure and adjuvant chemotherapy and has made a good recovery with no progression of her retinopathy. To our knowledge, this is one of the first descriptions of CAR in the context of pancreatic malignancy. It is atypical in its asymmetric presentation and favourable patient outcome. CAR is an important diagnosis to make, as ocular manifestations can be the only indication of an occult malignancy, resulting in a swifter diagnosis and potentially life-saving early intervention.

Cloudy corneas as an initial presentation of multiple myeloma

Summary

We report a case of previously unsuspected myeloma, presenting with cornea verticillata due to intracorneal paraprotein deposition.

History

An 85-year-old female presented via her optician with a 4-month history of cloudy vision. She had undergone an uneventful bilateral phacoemulsification surgery 7 years earlier. Extensive spiraling corneal epithelial opacification was noted on slit-lamp examination. On further investigation, she was found to have a previously unsuspected low-grade multiple myeloma. We established the nature of the corneal deposits with corneal epithelial biopsy histopathology and electron microscopy. It is very rare for multiple myeloma to present in this fashion. Ophthalmologists should be aware that such a presentation may rarely be due to systemic multiple myeloma.

Cancer-associated retinopathy presenting as retinal vasculitis with a negative ERG suggestive of on-bipolar cell pathway dysfunction

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.

Cancer-associated retinopathy (CAR) with electronegative ERG: a case report

Cancer-associated retinopathy (CAR) should be suspected in patients who present with visual symptoms such as rapid unexplained visual loss and seeing shimmering lights, with an abnormal ERG. Electronegative ERG responses are not exclusive to melanoma-associated retinopathy (MAR) but may be seen in CAR as well. We describe a patient with CAR who presented with an electronegative ERG. A 67-year old woman, who presented with complaints of seeing shimmering lights, underwent an extensive ophthalmological and electrophysiological examination. Best-corrected visual acuity was 7/10 in the right and 9/10 in the left eye. Goldmann visual fields showed relative central scotomata and concentric narrowing. Slit-lamp and fundus examination were normal as was fluorescein angiography. Rod-specific ERG responses were severely reduced, with electronegative maximal combined rod-cone responses and delayed cone-responses with normal amplitudes. Melanoma-associated retinopathy was suspected. Extensive dermatological and internal evaluation eventually revealed an oat-cell carcinoma in the right lung. The patient died of pneumonia 2 years after presentation.