1
|
Heng JS, Kim JM, Jones DK, Stoessel KM, Weiss SA, Sznol M, Kluger HM, Walter SD, Silverstein NA, Pointdujour-Lim R. Autoimmune retinopathy with associated anti-retinal antibodies as a potential immune-related adverse event associated with immunotherapy in patients with advanced cutaneous melanoma: case series and systematic review. BMJ Open Ophthalmol 2022; 7:e000889. [PMID: 35047671 PMCID: PMC8724805 DOI: 10.1136/bmjophth-2021-000889] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 12/04/2021] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To demonstrate the spectrum of autoimmune retinopathy (AIR) associated with immunotherapy for advanced cutaneous melanoma. METHODS AND ANALYSIS Retrospective chart review on patients with advanced cutaneous melanoma who developed AIR after initiating immunotherapy. Complete ophthalmic examination and relevant ancillary testing were performed on each patient. The presence of AIR-associated anti-retinal antibodies was confirmed by western blot and/or immunohistochemical staining. Ophthalmic and systemic outcomes after treatment for AIR were followed over time. A systematic review of AIR associated with immunotherapy for cutaneous or non-ocular mucosal melanoma was carried out in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS Case 1 developed photopsia and nyctalopia with electroretinographic findings characteristic for melanoma-associated retinopathy 1 week after initiating ipilimumab/nivolumab immunotherapy. Case 2 experienced new severe bilateral visual field loss associated with anti-retinal and anti-optic nerve antibodies while on maintenance nivolumab immunotherapy. Case 3 developed decreased visual acuity due to acute exudative polymorphous vitelliform maculopathy within 2 weeks of initiating ipilimumab/nivolumab immunotherapy. All patients had concurrent extraocular immune-related adverse events in addition to the presence of anti-retinal antibodies on serological testing. 14 published cases of AIR associated with immunotherapy for cutaneous or non-ocular mucosal melanoma were identified and reviewed. CONCLUSIONS Immune checkpoint inhibition can trigger the development of AIR with varied clinical manifestations in patients with advanced cutaneous melanoma. This study highlights the need for close monitoring in cutaneous melanoma patients receiving immunotherapy who develop new visual symptoms with or without funduscopic changes, as well as the potential role for screening of patients prior to initiating immunotherapy.
Collapse
Affiliation(s)
- Jacob S Heng
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jenna M Kim
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut, USA
| | - D Kyle Jones
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut, USA
| | - Kathleen M Stoessel
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut, USA
| | - Sarah A Weiss
- Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut, USA
| | - Mario Sznol
- Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut, USA
| | - Harriet M Kluger
- Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut, USA
| | - Scott D Walter
- Retina Consultants, P.C, Hartford, Connecticut, USA
- Hartford HealthCare Cancer Institute, Hartford Hospital, Hartford, Connecticut, USA
| | | | - Renelle Pointdujour-Lim
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut, USA
- Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut, USA
| |
Collapse
|
2
|
Gameiro Filho AR, Sturzeneker G, Rodriguez EEC, Maia A, Morales MC, Belfort RN. Acute exudative polymorphous paraneoplastic vitelliform maculopathy (AEPPVM) associated with choroidal melanoma. Int J Retina Vitreous 2021; 7:27. [PMID: 33795031 PMCID: PMC8017785 DOI: 10.1186/s40942-021-00300-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 03/23/2021] [Indexed: 11/30/2022] Open
Abstract
Background To report a case of acute exudative polymorphous paraneoplastic vitelliform maculopathy in a patient with a history of choroidal melanoma, with metastases to the pancreas, liver, and central nervous system. Case presentation A 63-year-old patient, with a history of enucleation of the right eye due to choroidal melanoma, complained of progressive visual loss during a follow-up visit. Fundoscopic examination revealed multiple small areas of serous retinal detachment scattered throughout the posterior pole and ancillary tests confirmed the diagnosis of acute exudative polymorphous paraneoplastic vitelliform maculopathy (AEPPVM). Screening for systemic metastases showed pancreatic, hepatic, and central nervous system involvement. Conclusions We describe a rare case of acute exudative polymorphous paraneoplastic vitelliform maculopathy, which should be considered in patients with or without a history of melanoma, who have vitelliform retinal detachments. Nevertheless, no previous reviews of literature have shown a correlation between AEPPVM and pancreatic metastasis.
Collapse
Affiliation(s)
- Aluisio Rosa Gameiro Filho
- Ophthalmology Department, Federal University of São Paulo (Unifesp-EPM), Rua Botucatu, 822, São Paulo, SP, 04023-062, Brazil.
| | - Guilherme Sturzeneker
- Ophthalmology Department, Federal University of São Paulo (Unifesp-EPM), Rua Botucatu, 822, São Paulo, SP, 04023-062, Brazil
| | - Ever Ernesto Caso Rodriguez
- Ophthalmology Department, Federal University of São Paulo (Unifesp-EPM), Rua Botucatu, 822, São Paulo, SP, 04023-062, Brazil
| | - André Maia
- Ophthalmology Department, Federal University of São Paulo (Unifesp-EPM), Rua Botucatu, 822, São Paulo, SP, 04023-062, Brazil
| | - Melina Correia Morales
- Ophthalmology Department, Federal University of São Paulo (Unifesp-EPM), Rua Botucatu, 822, São Paulo, SP, 04023-062, Brazil
| | - Rubens N Belfort
- Ophthalmology Department, Federal University of São Paulo (Unifesp-EPM), Rua Botucatu, 822, São Paulo, SP, 04023-062, Brazil
| |
Collapse
|
3
|
The role of Checkpoint Inhibitors in Paraneoplastic Acute Exudative Polymorphous Vitelliform Maculopathy: report of two cases. Retin Cases Brief Rep 2020; 16:614-618. [PMID: 32740323 DOI: 10.1097/icb.0000000000001040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To report on two cases with paraneoplastic Acute Exudative Polymorphous Vitelliform Maculopathy (AEPVM) within one month after the initiation of nivolumab. METHODS Case report RESULTS:: Two patients with metastatic mucosal melanoma were diagnosed with AEPVM within one month after the initiation of the checkpoint inhibitor nivolumab. Both cases showed a neurosensory retinal detachment and subretinal hyperautofluorescent material, which persisted after discontinuation of nivolumab and treatment with local and/or systemic corticosteroids. In one case nivolumab was introduced again in a later stage in combination with surgical reduction of the tumor, eventually leading to resolution of the subretinal lipofuscin rich fluid. CONCLUSION The development of paraneoplastic AEPVM in melanoma patients can be triggered by treatment with nivolumab. However achieving tumor control, which may involve continuation of nivolumab, could be the key to success.
Collapse
|
4
|
Saakyan SV, Myakoshina EB. [Melanoma-associated vitelliform retinopathy (a clinical case study)]. Vestn Oftalmol 2018; 134:61-67. [PMID: 30166512 DOI: 10.17116/oftalma201813404161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Melanoma-associated vitelliform retinopathy is a manifestation of paraneoplastic syndrome in skin melanoma. Paraneoplastic syndrome, while not being a tumor or a metastatic disease, is regarded as a tumor-associated disease related to extraocular localization of neoplasm. In this clinical case, the diagnosis of melanoma-associated vitelliform retinopathy was based on a combination of clinical, angiographic, autofluorescence and morphometric signs of bilateral lesion. Analysis of the case showed that in common oncological diseases and complaints of visual impairment, examination of eye fundus is mandatory in order to timely diagnose the changes associated with tumor lesion. Detection of bilateral lesions with oval grey-yellow multiple foci at the level of retinal pigment epithelium may indicate melanoma-associated vitelliform retinopathy that requires diagnostic search for skin melanoma. A complex of instrumental studies including fluorescent angiography, optical coherence tomography and autofluorescence with feature identification allowed establishing the correct diagnosis in the particular case.
Collapse
Affiliation(s)
- S V Saakyan
- Moscow Helmholtz Research Institute of Eye Diseases, 14/19 Sadovaya-Chernogryazskaya St., Moscow, Russian Federation, 105062
| | - E B Myakoshina
- Moscow Helmholtz Research Institute of Eye Diseases, 14/19 Sadovaya-Chernogryazskaya St., Moscow, Russian Federation, 105062
| |
Collapse
|
5
|
Nagiel A, Rootman DB, McCannel TA. PARANEOPLASTIC VITELLIFORM MACULOPATHY IN THE SETTING OF CHOROIDAL MELANOMA: EVOLUTION OVER ONE YEAR. Retin Cases Brief Rep 2017; 11 Suppl 1:S7-S10. [PMID: 27533643 DOI: 10.1097/icb.0000000000000383] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND To illustrate the evolution of paraneoplastic vitelliform maculopathy over one year using optical coherence tomography. METHODS Observational case report. RESULTS A 65-year-old man with a history of ocular melanocytosis and choroidal melanoma of the left eye treated with plaque brachytherapy 3 years prior returned for his yearly follow-up visit. The visual acuity in the right eye was 20/20. Subtle thickening of the interdigitation zone layer was noted on optical coherence tomography. Over the following year, multifocal vitelliform detachments developed with progressive enlargement and coalescence of the lesions. Paraneoplastic vitelliform maculopathy developed in the fellow eye of a patient with local recurrence of previously treated choroidal melanoma. CONCLUSION Paraneoplastic vitelliform maculopathy may develop in the fellow eye of a patient with local recurrence of their previously treated choroidal melanoma with no clinical evidence of systemic metastasis.
Collapse
Affiliation(s)
- Aaron Nagiel
- *Retina Division, Stein Eye Institute, Los Angeles, California; †Orbital and Ophthalmic Plastic Surgery Division, Stein Eye Institute, Los Angeles, California; and ‡Doheny Eye Institute, Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | | | | |
Collapse
|
6
|
van Dijk EHC, van Herpen CML, Marinkovic M, Haanen JBAG, Amundson D, Luyten GPM, Jager MJ, Kapiteijn EHW, Keunen JEE, Adamus G, Boon CJF. Serous Retinopathy Associated with Mitogen-Activated Protein Kinase Kinase Inhibition (Binimetinib) for Metastatic Cutaneous and Uveal Melanoma. Ophthalmology 2015; 122:1907-16. [PMID: 26123090 DOI: 10.1016/j.ophtha.2015.05.027] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 05/15/2015] [Accepted: 05/15/2015] [Indexed: 01/05/2023] Open
Abstract
PURPOSE To analyze the clinical characteristics of a serous retinopathy associated with mitogen-activated protein kinase kinase (MEK) inhibition with binimetinib treatment for metastatic cutaneous melanoma (CM) and uveal melanoma (UM), and to determine possible pathogenetic mechanisms that may lead to this retinopathy. DESIGN Prospective observational, cohort-based, cross-sectional study. PARTICIPANTS Thirty CM patients and 5 UM patients treated with the MEK inhibitor binimetinib (CM) or a combination of binimetinib and the protein kinase C inhibitor sotrastaurin (UM). METHODS Extensive ophthalmic examination was performed, including Early Treatment of Diabetic Retinopathy Study best-corrected visual acuity, applanation tonometry, slit-lamp examination, indirect ophthalmoscopy, digital color fundus photography, and optical coherence tomography (OCT). In selected cases, additional examinations were performed, including visual field testing and electro-oculography (EOG). Blood samples were obtained from 3 CM patients and 3 UM patients to analyze the presence of autoantibodies against retinal and retinal pigment epithelium (RPE) proteins. MAIN OUTCOME MEASURES Visual symptoms, visual acuity, fundus appearance, characteristics on OCT, fundus autofluorescence (FAF), and EOG. RESULTS Six CM patients (20%) and 2 UM patients (40%) reported visual symptoms during the study. The median time to the onset of symptoms, which were all mild and transient, was 3.5 days (range, <1 hour to 3 weeks). On OCT, subretinal fluid (SRF) was detected in 77% of CM patients and 60% of UM patients. In the 26 patients with SRF, the fovea was affected in 85%. After the start of the medication, an EOG was performed in 19 eyes of 11 patients; 16 of these eyes (84%) developed SRF on OCT. Fifteen of these eyes (94%) showed an abnormal Arden ratio (<1.65). A broad pattern of anti-retinal antibodies was found in 3 CM patients and 2 UM patients tested, whereas anti-RPE antibodies were detected in all 6 tested patients. CONCLUSIONS A time-dependent and reversible serous retinopathy can develop both in patients with metastatic CM and UM treated with binimetinib. A minority of patients develop visual symptoms, which are generally mild and transient. A cause of binimetinib-associated serous retinopathy may be toxicity of medication, but autoantibodies also may be involved.
Collapse
Affiliation(s)
- Elon H C van Dijk
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| | - Carla M L van Herpen
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marina Marinkovic
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands; Department of Ophthalmology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - John B A G Haanen
- Division of Medical Oncology, The Netherlands Cancer Institute Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Drake Amundson
- Department of Ophthalmology, Oregon Health and Science University, Portland, Oregon
| | - Gré P M Luyten
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| | - Martine J Jager
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ellen H W Kapiteijn
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jan E E Keunen
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Grazyna Adamus
- Department of Ophthalmology, Oregon Health and Science University, Portland, Oregon
| | - Camiel J F Boon
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands.
| |
Collapse
|
7
|
Dalvin LA, Johnson AA, Pulido JS, Dhaliwal R, Marmorstein AD. Nonantibestrophin Anti-RPE Antibodies in Paraneoplastic Exudative Polymorphous Vitelliform Maculopathy. Transl Vis Sci Technol 2015; 4:2. [PMID: 26046004 DOI: 10.1167/tvst.4.3.2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 04/02/2015] [Indexed: 12/11/2022] Open
Abstract
PURPOSE A previous report demonstrated antibodies to bestrophin in paraneoplastic exudative polymorphous vitelliform maculopathy (PEPVM). Other cases demonstrated antibodies to different proteins in the retinal pigment epithelium (RPE). In this report, serum was analyzed to determine whether a patient with PEPVM and a reduced Arden ratio had developed autoantibodies to human Bestrophin-1 (Best1). METHODS Human embryonic kidney 293 cells (HEK293) were transfected with Best1 and stained with an antibody specific to Best1 (E6-6), or patient serum. Staining patterns were compared with those of untransfected cells stained with E6-6, patient serum, control serum, or secondary antibody alone. Western blots were performed using lysed RPE and stained with E6-6, patient serum, control serum, or secondary antibody alone. RESULTS Immunofluorescence staining of HEK-293 cells or HEK-293 cells expressing Best1 did not differ between patient and control sera or show a staining pattern consistent with recognition of Best1. Immunoblotting of human RPE lysate with patient serum did not identify Best1 (68 kDa) but did recognize a band at approximately 48 kDa that was absent in blots using control serum. CONCLUSIONS To our knowledge, this is the first report of PEPVM with an autoantibody to an approximately 48-kDa RPE protein, but previous reports have demonstrated autoantibodies to other RPE proteins, suggesting that autoantibody formation is an important component of PEPVM. TRANSLATIONAL RELEVANCE This research emphasizes the role that autoantibodies play in PEPVM. The fact that different autoantibodies appear to cause similar patterns demonstrates the heterogeneity of causes of vitelliform lesions.
Collapse
Affiliation(s)
| | | | - Jose S Pulido
- Department of Ophthalmology Mayo Clinic, Rochester, MN, USA ; Molecular Medicine, Mayo Clinic, Rochester, MN, USA
| | | | | |
Collapse
|
8
|
Paraneoplastic vitelliform retinopathy in a patient with treated choroidal melanoma. Retin Cases Brief Rep 2014; 8:269-72. [PMID: 25372525 DOI: 10.1097/icb.0000000000000098] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To describe a peculiar case of paraneoplastic vitelliform maculopathy/retinopathy in a patient with treated choroidal melanoma. METHODS A case report of a 58-year-old woman with a history of treated choroidal melanoma 16 years before developing visual changes in the setting of metastatic choroidal melanoma. RESULTS We demonstrate bilateral, multifocal vitelliform subretinal lesions and focal, neurosensory retinal detachment associated with metastatic melanoma. CONCLUSION Paraneoplastic vitelliform maculopathy/retinopathy should be considered in patients with or without a history of melanoma, who have unexplained serous, vitelliform retinal detachments, especially with atypical or absence of leakage on fluorescein angiography.
Collapse
|
9
|
|
10
|
|
11
|
Rahimy E, Sarraf D. Paraneoplastic and non-paraneoplastic retinopathy and optic neuropathy: Evaluation and management. Surv Ophthalmol 2013; 58:430-58. [DOI: 10.1016/j.survophthal.2012.09.001] [Citation(s) in RCA: 138] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Revised: 08/27/2012] [Accepted: 12/04/2012] [Indexed: 12/29/2022]
|
12
|
Aronow ME, Adamus G, Abu-Asab M, Wang Y, Chan CC, Singh AD. Paraneoplastic vitelliform retinopathy: clinicopathologic correlation and review of the literature. Surv Ophthalmol 2012; 57:558-64. [PMID: 22784677 PMCID: PMC3470815 DOI: 10.1016/j.survophthal.2012.02.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2011] [Revised: 02/01/2012] [Accepted: 02/07/2012] [Indexed: 10/28/2022]
Abstract
Traditionally, the paraneoplastic retinopathies have been classified into two groups: melanoma-associated retinopathy (MAR) and cancer-associated retinopathy. MAR occurs in individuals with metastatic cutaneous or uveal melanoma and is characterized by nyctalopia, photopsias, and variable vision loss. In most cases, the fundus is essentially normal in appearance. More recently, there have been multiple reports of a MAR-like retinopathy with associated detachments of the retinal pigment epithelium and neurosensory retina. Such a clinical presentation has been termed paraneoplastic vitelliform retinopathy. We describe an 80-year-old man with metastatic cutaneous melanoma who developed paraneoplastic vitelliform retinopathy. For the first time, histopathology from enucleation specimens provides a clinicopathologic disease correlation with focal abnormalities in the inner nuclear and outer plexiform layers.
Collapse
Affiliation(s)
- Mary E. Aronow
- Department of Ophthalmic Oncology, Cole Eye Institute, Cleveland Clinic, Cleveland, OH
| | - Grazyna Adamus
- Casey Eye Institute, Oregon Health & Science University, Portland, OR
| | - Mones Abu-Asab
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, MD
| | - Yujuan Wang
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, MD
| | - Chi-Chao Chan
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, MD
| | - Arun D. Singh
- Department of Ophthalmic Oncology, Cole Eye Institute, Cleveland Clinic, Cleveland, OH
| |
Collapse
|
13
|
Al-Dahmash SA, Shields CL, Bianciotto CG, Witkin AJ, Witkin SR, Shields JA. Acute exudative paraneoplastic polymorphous vitelliform maculopathy in five cases. Ophthalmic Surg Lasers Imaging Retina 2012; 43:366-73. [PMID: 22822903 DOI: 10.3928/15428877-20120712-01] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2011] [Accepted: 05/01/2012] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To evaluate clinical features, course, and outcome of patients with acute exudative paraneoplastic polymorphous vitelliform maculopathy (AEPPVM). PATIENTS AND METHODS Retrospective case series of 5 patients. RESULTS There were 3 males and 2 females, with a median age of 74 years. The primary neoplasms were cutaneous melanoma (n = 2), choroidal melanoma (n = 1), lung adenocarcinoma (n = 1), and lung plus breast adenocarcinoma (n = 1). The mean interval between the diagnosis of the primary neoplasm and the diagnosis of AEPPVM was 42 months. The presenting symptom was blurred vision in all cases. Ophthalmoscopy disclosed multifocal localized shallow serous detachments of the post-equatorial neurosensory retina with yellow-white subretinal debris confirmed by optical coherence tomography (OCT). There was a mean of 21 individual sites of detachment per eye, each measuring a mean of approximately 0.8 millimeter in diameter. Fundus autofluorescence depicted hyperautofluorescence corresponding to the detachments. After mean follow-up of 5 months, three patients had died of metastases. Of the two survivors, one showed resolution of lesions and the other was unchanged. CONCLUSION AEPPVM is a paraneoplastic retinopathy found in patients with metastatic melanoma or carcinoma. The most salient feature is reduced visual acuity from multifocal shallow retinal detachments less than 1-mm diameter, best depicted on OCT.
Collapse
Affiliation(s)
- Saad A Al-Dahmash
- Ocular Oncology Service, Wills Eye Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | | | | | | | | |
Collapse
|
14
|
Nieuwendijk TJP, Hooymans JMM. Paraneoplastic vitelliform retinopathy associated with metastatic choroidal melanoma. Eye (Lond) 2007; 21:1436-7. [PMID: 17693995 DOI: 10.1038/sj.eye.6702949] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
|
15
|
Ladewig G, Reinhold U, Thirkill CE, Kerber A, Tilgen W, Pföhler C. Incidence of antiretinal antibodies in melanoma: screening of 77 serum samples from 51 patients with American Joint Committee on Cancer stage I-IV. Br J Dermatol 2005; 152:931-8. [PMID: 15888149 DOI: 10.1111/j.1365-2133.2005.06480.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patients with melanoma-associated retinopathy (MAR) experience different visual symptoms caused by the production of antitumoral antibodies that cross-react with retinal epitopes. Immunofluorescence assays of serum from patients with MAR on sectioned monkey or human retina characteristically reveal antibody activity located within the inner nuclear layer, with a focus of activity upon the membranes of bipolar cells. OBJECTIVES We inquired into the association with disease of this serological abnormality by evaluating sera from patients with melanoma with no MAR-like signs or symptoms. METHODS Groups of patients were selected with different stages of melanoma (American Joint Committee on Cancer stages I-IV). Seventy-seven serum samples from 51 patients with melanoma were examined by indirect immunohistochemical assay on sections of human retina. RESULTS Of the 77 serum samples, 53 were found to contain antibodies reactive with various components of retina. Eight were from 17 sera from patients in stage I or II, 14 were from 23 sera from patients in stage III, and 31 were from 37 sera from patients in stage IV. Statistical analysis revealed a correlation between antibody activity and the stage of disease, with a higher percentage of antibody activity in advanced stages (P = 0.002). CONCLUSIONS The presence of antiretinal antibodies in patients with melanoma without ocular symptoms appears to be more common than previously suspected. Antibody activity similar to that ascribed to the MAR syndrome appears in some patients with melanoma who have no MAR-like retinopathy. Follow-up studies will determine if patients with antiretinal antibodies go on to develop MAR and if staining intensity and staining patterns change over the course of the disease.
Collapse
Affiliation(s)
- G Ladewig
- Department of Dermatology, The Saarland University Hospital , 66421 Homburg/Saar, Germany
| | | | | | | | | | | |
Collapse
|
16
|
Kaplan J, Friberg T. 810 nm diode grid laser treatment for massive chronic serous retinal detachment following combined kidney and pancreas organ transplantation. Semin Ophthalmol 2004; 19:109-13. [PMID: 15590549 DOI: 10.1080/08820530490882562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
An insulin-dependent diabetic woman of 42 years received a combined pancreas and kidney transplant five years prior to referral to our clinic for ophthalmic consultation. Her systemic immunosupression included oral steroids and she subsequently developed huge bilateral central serous retinal detachments affecting both posterior poles and the temporal midperiphery of the left eye. Her vision was reduced to count fingers (CF) in both eyes. Fluorescein angiography (FA) revealed diffuse mild retinal pigment epithelium (RPE) staining in both eyes. As an empiric treatment grid laser photocoagulation with an 810 nm diode laser (Iridex Corp., Mountain View, California) was performed with complete resorption of subretinal fluid in both eyes and visual improvement to 20/70 in the right eye and 20/200 in the left eye at 18 months post-treatment. In patients diagnosed with atypical central serous retinal detachment whose fluorescein angiogram displays widespread RPE damage and in whom systemic steroids are medically necessary, diode grid laser photocoagulation may be a reasonable treatment option.
Collapse
Affiliation(s)
- Jason Kaplan
- University of Pittsburg Eye Center, UPMC Medical Center, Pittsburg, PA 15213, USA
| | | |
Collapse
|