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Cox JT, Minkus CL, Li A, Han S, Liu R, Shah P, Stanwyck LK, Rizzo JF, Sobrin L. Autoimmune Retinopathy: Intravenous Immunoglobulin Treatment versus Natural History. Ophthalmol Retina 2024:S2468-6530(24)00080-0. [PMID: 38428458 DOI: 10.1016/j.oret.2024.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/20/2024] [Accepted: 02/22/2024] [Indexed: 03/03/2024]
Affiliation(s)
- Jacob T Cox
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
| | - Caroline L Minkus
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts; Department of Ophthalmology, Park Nicollet Clinic, St. Louis Park, Minnesota
| | - Ashley Li
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
| | - Samuel Han
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
| | - Renee Liu
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
| | - Priya Shah
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
| | - Lynn K Stanwyck
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
| | - Joseph F Rizzo
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
| | - Lucia Sobrin
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts.
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Bergman Z, Mohammed T, Schocket L, Aouchiche R, Johnson MA. Autoimmune retinopathy in a patient with smoldering multiple myeloma: a case report. Doc Ophthalmol 2024:10.1007/s10633-024-09965-y. [PMID: 38363513 DOI: 10.1007/s10633-024-09965-y] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 01/08/2024] [Indexed: 02/17/2024]
Abstract
PURPOSE Multiple myeloma (MM) is a plasma cell dyscrasia leading to proliferation of monoclonal plasma cells. Ocular involvement in multiple myeloma is uncommon but can occur. The ocular manifestations of MM may include the cornea, uvea, and retinal vasculature. We present a rare case of autoimmune retinopathy associated with smoldering MM. CASE A 76-year-old female with no significant past medical or ocular history presented with four months of worsening vision, difficulty with night driving, and loss of peripheral vision. Examination was notable for pallor of the optic nerves and vascular attenuation. Visual field testing demonstrated significant and progressive field loss in both eyes. An electroretinogram was extinguished under all conditions. Serum protein electrophoresis showed a significant elevation of IgG with an M-spike, and a subsequent bone marrow biopsy was performed showing 12.5% plasma cells, consistent with the diagnosis of MM. CAR antibody testing was positive for anti-enolase, anti-GAPDH, and anti-Rab6 antibodies, consistent with autoimmune retinopathy. DISCUSSION Autoimmune retinopathy associated with MM is exceedingly rare. Management of this condition is challenging, as treatment of the underlying disease does not often lead to improvement in visual symptoms. Ultimately, visual prognosis is very poor, and both patients and clinicians should be aware of the guarded visual potential. CONCLUSION The association of autoimmune retinopathy with multiple myeloma is rare. It is crucial for physicians to be aware of such manifestations to ensure timely and appropriate diagnosis and management for patients.
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Affiliation(s)
- Zachary Bergman
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, 419 Redwood Street, Suite 420, Baltimore, MD, 21201, USA
| | - Taariq Mohammed
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, 419 Redwood Street, Suite 420, Baltimore, MD, 21201, USA.
| | - Lisa Schocket
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, 419 Redwood Street, Suite 420, Baltimore, MD, 21201, USA
| | - Rachid Aouchiche
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, 419 Redwood Street, Suite 420, Baltimore, MD, 21201, USA
| | - Mary A Johnson
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, 419 Redwood Street, Suite 420, Baltimore, MD, 21201, USA
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Kim D, Jang JK, Sung Y. Sight-Threatening Immune Retinopathy Developing Secondary to Durvalumab Treatment of Small-Cell Lung Cancer: A Case Report. Case Rep Ophthalmol 2024; 15:343-352. [PMID: 38623406 PMCID: PMC11018330 DOI: 10.1159/000538246] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 02/29/2024] [Indexed: 04/17/2024] Open
Abstract
Introduction Given the recent additions of immune checkpoint inhibitors (ICIs) to various cancer treatments, adverse effects, especially involving the eyes, have been on the rise. Here, we report an acute exacerbation of cancer-associated retinopathy (CAR) triggered by durvalumab treatment of small-cell lung cancer (SCLC). Case Presentation An 81-year-old Asian male complained of a scotoma in the left eye after durvalumab administration, to treat SCLC. Humphrey visual field examination revealed a C-shaped temporal scotoma. Spectralis domain optical coherence tomography revealed outer retinal layer atrophy and progressive loss of the ellipsoid zone in the atrophic peripapillary area. Fundus autofluorescence (AF) images evidenced a large C-shaped hypo-AF with enhanced AF at the margin of the atrophic area, thus at the position of the scotoma. We prescribed subtenon triamcinolone injections under suspicion of CAR exacerbation, supported by positive Western blotting results for Rab6 and aldolase, and immunohistochemical staining of photoreceptor cells. The disrupted ellipsoid zone evident on OCT partially recovered, and a visual field test showed that the scotoma had improved. Conclusion ICI-triggered exacerbation of CAR should be considered in SCLC patients before ICI treatment commences; an optimal treatment should preserve functional vision.
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Affiliation(s)
- Doah Kim
- Department of Ophthalmology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Jeong Kyeong Jang
- Department of Ophthalmology, Catholic University of Korea Yeouido Saint Mary’s Hospital, Seoul, Republic of Korea
| | - Youngje Sung
- Department of Ophthalmology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
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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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Thomas M, Benfield J, Morales J. Case Report of Seronegative Cancer-Associated Retinopathy in a Patient with Small Cell Lung Carcinoma. Case Rep Oncol 2023; 16:791-796. [PMID: 37900796 PMCID: PMC10601748 DOI: 10.1159/000531624] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 06/13/2023] [Indexed: 10/31/2023] Open
Abstract
Cancer-associated retinopathy (CAR) is a rare paraneoplastic syndrome characterized by autoimmune destruction of photoreceptor cells. It is associated with several tumor types, including small cell lung carcinoma (SCLC). Corticosteroids have been the mainstay treatment for CAR, although no therapeutic standard has truly been established. A 66-year-old female with significant smoking history and age-related macular degeneration (ARMD) presented with rapidly declining bilateral visual acuity. Ophthalmologic examination findings appeared consistent with the known diagnosis of ARMD but did not otherwise present a clear alternative etiology. Imaging with a computed tomography (CT) scan revealed a right hilar mass which was confirmed to be limited stage SCLC based on a subsequent biopsy and further imaging with a positron emission tomography/computed tomography (PET/CT) scan. Antibody testing was negative for anti-recoverin antibodies. The patient experienced a complete response to chemoradiation with cisplatin and etoposide; however, her ocular symptoms did not respond to a combined treatment approach with corticosteroids, plasmapheresis, and intravenous immunoglobulin (IVIG). While CAR represents a rare condition in SCLC, cases that are seronegative for anti-recoverin are even less common. Further, the diagnosis of CAR by ophthalmologic examination may be more challenging in patients with pre-existing ocular diseases, such as macular degeneration. Clinicians should have suspicion for paraneoplastic blindness in patients with known risk factors for malignancy, whose ocular symptoms are inconsistent with exam findings.
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Affiliation(s)
- Miles Thomas
- Internal Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - John Benfield
- Internal Medicine, Carilion Clinic, Roanoke, VA, USA
| | - Joshua Morales
- Medical Oncology, Blue Ridge Cancer Care, Roanoke, VA, USA
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Abstract
Paraneoplastic syndrome is a group of clinical symptoms that occur in the state of systemic malignant tumors. Paraneoplastic syndrome of the nervous system can affect any part of the central and peripheral nervous system and may also affect the eyes. In neuroophthalmology, paraneoplastic syndrome has a variety of manifestations that can affect both the afferent and efferent visual systems. The afferent system may involve the optic nerve, retina and uvea; the efferent system may involve eye movement, neuromuscular joints or involuntary eye movements and pupil abnormalities and may also have other neurological symptoms outside the visual system. This article discusses the clinical manifestations, pathological mechanisms, detection methods and treatment methods of paraneoplastic syndrome in neuroophthalmology. The performance of paraneoplastic syndrome is diverse, the diagnosis is difficult, and the treatment should be considered systematically. Differential diagnosis, optimal evaluation and management of these manifestations is not only the key to treatment but also a challenge.
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Affiliation(s)
- Longdan Kang
- Department of Ophthalmology, The First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, China
| | - Chao Wan
- Department of Ophthalmology, The First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, China.
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Dimitriou E, Chatzirallis A, Katopodis S, Theodossiadis G, Theodossiadis P, Chatziralli I. Cancer-associated retinopathy 4 years after surgery for ovarian cancer. Oman J Ophthalmol 2021; 14:108-111. [PMID: 34345145 PMCID: PMC8300284 DOI: 10.4103/ojo.ojo_352_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 05/06/2021] [Indexed: 12/03/2022] Open
Abstract
A 71-year-old woman presented with progressive, bilateral, blurred vision and nyctalopia for the last 6 months. Her past medical history included total hysterectomy and chemotherapy for ovarian cancer 4 years ago, without metastases. Optical coherence tomography revealed outer retinal layers' thinning bilaterally, while diffuse retinal pigment epithelium abnormalities were found in fundus autofluorescence. Full-field electroretinogram showed abnormalities in both a- and b-waves with significant reduction of retinal sensitivity, affecting however more the rod system. The patient was positive for alpha-enolase and was diagnosed with cancer-associated retinopathy (CAR), which developed 4-year primary cancer. Computerized tomography scan revealed an enlarged para-aortic lymph node at the left kidney, and the patient was started on chemotherapy, combined with immunosuppressive treatment. In conclusion, CAR should be suspected in patients experiencing unexplained visual disturbances, especially in the context of previous cancer.
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Affiliation(s)
- Eleni Dimitriou
- Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Sokratis Katopodis
- Propaedeutic Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - George Theodossiadis
- Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Irini Chatziralli
- Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, Greece
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Wagley S, Tran TM, Mallory PW, Lee MS, Armbrust KR, Trautman B, Montezuma SR. Cancer-Associated Retinopathy due to Clear Cell Renal Carcinoma. Ocul Oncol Pathol 2020; 7:31-35. [PMID: 33796514 DOI: 10.1159/000511189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 08/21/2020] [Indexed: 11/19/2022] Open
Abstract
An 84-year-old female presented with bilateral scotomas and progressive nyctalopia over 1 year. Best-corrected visual acuity was 20/50 in both eyes with reduced color vision. Goldmann visual field showed bilateral cecocentral scotomas and generalized constriction of the visual fields. This led to an electroretinogram showing an electronegative pattern consistent with autoimmune retinopathies. Infectious workup was negative. Anti-retinal antibodies were positive, leading to a presumed diagnosis of cancer-associated retinopathy (CAR). Imaging showed a previously unknown left renal lower pole mass, and she underwent a radical nephrectomy. Biopsy showed nuclear grade-3 clear cell renal carcinoma staged T1. The patient was treated with oral prednisone with no ocular improvement. We report on a rare case of clear cell renal carcinoma causing CAR. CAR is an important paraneoplastic syndrome to diagnose since the majority of ocular cases precede other manifestations of malignancy. Therefore, a timely diagnosis of CAR can be lifesaving or at least life-extending.
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Affiliation(s)
- Sushant Wagley
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota, USA
| | - Tu M Tran
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota, USA
| | - Paul W Mallory
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota, USA
| | - Michael S Lee
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota, USA
| | | | - Bruce Trautman
- Anatomic Pathology, Fairview Southdale Hospital, Edina, Minnesota, USA
| | - Sandra R Montezuma
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota, USA
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Carrera W, Tsamis KA, Shah R. A case of cancer-associated retinopathy with chorioretinitis and optic neuritis associated with occult small cell lung cancer. BMC Ophthalmol 2019; 19:101. [PMID: 31046716 PMCID: PMC6498699 DOI: 10.1186/s12886-019-1103-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 04/08/2019] [Indexed: 11/10/2022] Open
Abstract
Background Cancer-associated retinopathy (CAR) is associated with various malignancies, including small cell lung cancer (SCLC). It is difficult to recognize, but prompt diagnosis is crucial for the patient, as retinopathy may be a herald sign that precedes systemic manifestations by months, thus allowing early treatment of the underlying malignancy. Case presentation We present a rare case of CAR with chorioretinitis and optic neuritis in a patient with occult SCLC. The patient presented with rapidly progressive peripheral field loss and photopsias with “prism-like” visual disturbances. Her symptoms stabilized with intravenous methylprednisolone, and her cancer was treated with carboplatin, etoposide and radiotherapy. Conclusions This is the first reported case of SCLC-associated CAR to present with chorioretinitis. CAR can be a herald feature of SCLC, and early recognition of the disease should prompt a systemic evaluation for an occult malignancy, which may be critical for patient survival. Further understanding of CAR pathogenesis may offer potential avenues for treatment.
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Affiliation(s)
- William Carrera
- Wake Forest Baptist Medical Center, 1 Medical Center Boulevard, Winston-Salem, North Carolina, 27157, USA
| | - Kathy A Tsamis
- Wake Forest Baptist Medical Center, 1 Medical Center Boulevard, Winston-Salem, North Carolina, 27157, USA
| | - Rajiv Shah
- Wake Forest Baptist Medical Center, 1 Medical Center Boulevard, Winston-Salem, North Carolina, 27157, USA.
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Igarashi N, Sawamura H, Kaburaki T, Aihara M. Cancer-associated Retinopathy Developing After 10 Years of Complete Breast Cancer Remission. Neuroophthalmology 2019; 43:36-42. [PMID: 30723523 DOI: 10.1080/01658107.2018.1460761] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 03/09/2018] [Accepted: 03/31/2018] [Indexed: 10/16/2022] Open
Abstract
A 73-year-old female with a past medical history of breast cancer, who 10 years earlier experienced complete remission, complained of bilateral visual field disturbances and photopsia, 2 months prior. Tumour recurrence and metastatic lesions were not found during the medical examination, but antibodies against recoverin were detected in her serum. Despite immunosuppressive treatment with prednisolone and plasmapheresis, rapid and diffuse degeneration of the patient's photoreceptors and deterioration of her visual field were observed. This is a rare case of cancer-associated retinopathy with a long interval (10 years) between the diagnosis of the malignancy and visual loss.
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Affiliation(s)
- Nozomi Igarashi
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Hiromasa Sawamura
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Toshikatsu Kaburaki
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Makoto Aihara
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
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Abstract
Background The early diagnosis of cancer is of crucial importance and a key prognostic factor. Cancer-associated retinopathy (CAR) can be symptomatic prior to other manifestations directly related to malignant tumors. The aim of this study was to show that, in selected cases, ophthalmic findings are consistent enough with the diagnosis of CAR to trigger investigations aimed at detecting a previously unknown malignancy. Methods This was a monocentric retrospective case series performed in a tertiary referral center. Patients with a diagnosis of CAR were included. Diagnosis was based on the clinical presentation, the visual field and electroretinogram alterations. The clinical presentation, visual field testing and electroretinographic results were analyzed as well as the malignancies identified following the diagnosis of CAR. Follow-up data was collected. Results Four patients (two men, two women, median age 65.5 years) were included. All patients presented with posterior segment inflammation at initial presentation as well as advanced visual field loss and an extinguished electroretinogram. The best corrected decimal visual acuity was 0.8 or better in both eyes of three patients and decreased to 0.3 OD and O.2 OS in one patient due to a bilateral macular edema. No patient had a previously known history of cancer. Once the diagnosis of CAR was made, investigations aimed at identifying a malignant tumors subsequently led to the diagnosis of two cases of small cell lung tumors, of one prostate carcinoma and of a uterine sarcoma. The treatment of CAR included plasmapheresis, systemic corticosteroids, azathioprine, cyclosporine and periocular or intraocular corticosteroid injections. In all cases the intraocular inflammation resolved, but pigment mottling, diffuse retinal atrophy, optic disc pallor and arterial narrowing were among manifestations observed during the follow-up of the patients. Conclusion In selected patients, findings suggestive of CAR can be useful for the early detection of a cancer. Electronic supplementary material The online version of this article (10.1186/s12886-018-0948-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Florence Hoogewoud
- Department of Ophthalmology, National Referral Center for rare Ocular Diseases, Hôpital Cochin, APHP, Université Paris Descartes, Paris, France.
| | - Pauline Butori
- Department of Ophthalmology, National Referral Center for rare Ocular Diseases, Hôpital Cochin, APHP, Université Paris Descartes, Paris, France
| | - Philippe Blanche
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, APHP, Paris, France
| | - Antoine P Brézin
- Department of Ophthalmology, National Referral Center for rare Ocular Diseases, Hôpital Cochin, APHP, Université Paris Descartes, Paris, France
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Abstract
A 75-year-old female patient presented with bilateral progressive loss of vision. Best corrected visual acuity (BCVA) was hand movements in the right eye and 1/50 in the left eye. The spectral domain optical coherence tomography (SD-OCT) showed thinning of the outer retina suspected to be due to autoimmune retinopathy. A neuroendocrine carcinoma of the uterus was diagnosed during tumor screening. Under systemic therapy with corticosteroids the visual acuity improved to 20/200 in the right eye and 20/80 in the left eye. Cancer-associated retinopathy (CAR) is a paraneoplastic autoimmune retinopathy.
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Affiliation(s)
- R Siggel
- Zentrum für Augenheilkunde, Universitätsklinikum Köln, Kerpener Str. 62, 50924, Köln, Deutschland.
| | - T Schick
- Zentrum für Augenheilkunde, Universitätsklinikum Köln, Kerpener Str. 62, 50924, Köln, Deutschland
| | - R S Grajewski
- Zentrum für Augenheilkunde, Universitätsklinikum Köln, Kerpener Str. 62, 50924, Köln, Deutschland
| | - S Liakopoulos
- Zentrum für Augenheilkunde, Universitätsklinikum Köln, Kerpener Str. 62, 50924, Köln, Deutschland
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Barba-Navarrete DM, Moreno-Páramo D, Corona-Montes VE, Tapia-López LE, Montiel-Delgado E. Ophthalmological changes of the posterior segment in patients with testicular cancer in a mixed-race population of the General Hospital of Mexico. ACTA ACUST UNITED AC 2018; 93:417-422. [PMID: 29907347 DOI: 10.1016/j.oftal.2018.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 05/05/2018] [Accepted: 05/09/2018] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The curing of a testicular tumour is currently feasible in more than 95% of patients, and in 80% of those with metastases. Until now, there has been no study or series of cases that describe the ocular changes of the posterior segment associated with testicular cancer. OBJECTIVE To evaluate patients with a diagnosis of testicular cancer in order to determine the presence of changes in the posterior segment and the relationship to the stage. MATERIAL AND METHOD An observational, cross-sectional, and descriptive study was conducted on 21 male patients (42 eyes) with a diagnosis of testicular cancer. Age, histological type, time of evolution, stage, treatment, and comorbidities were recorded, as well as visual acuity measurement (LogMAR), biomicroscopy of the anterior segment, and photographic records of the posterior pole and peripheral retina. RESULTS The mean age was 29 years (18-43 years). All (100%) of the patients were treated surgically. The most frequent histological type was classic seminoma (42.8%), followed by the mixed germinal tumour (38.0%). At the time of evaluation, 42.8% of patients had a stage II, and 23.8% had distant metastasis. The changes in the posterior segment were: vascular tortuosity (14.2%), retinopathy associated with cancer (9.5%), choroidal metastasis (9.5%), pigmentary changes of the retinal pigment epithelium (9.5%), and retinal metastasis (4.7%). CONCLUSIONS It is possible to find changes at the level of retinal pigment epithelium, as well as vascular tortuosity, retinopathy associated with cancer, and choroidal and/or retina metastases.
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Affiliation(s)
| | - D Moreno-Páramo
- Servicio de Retina, Hospital General de México, Ciudad de México, México
| | - V E Corona-Montes
- Servicio de Urología Oncológica, Hospital General de México, Ciudad de México, México
| | - L E Tapia-López
- Asociación Para Evitar la Ceguera en México, Ciudad de México, México
| | - E Montiel-Delgado
- Servicio de Urología Oncológica, Hospital General de México, Ciudad de México, México
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Kamei M, Fujitomi Y, Kondo Y, Adachi T, Shibata K, Takumi Y, Abe M, Sugio K. Cancer-associated retinopathy after surgery for breast cancer: a case report and review of the literature. Surg Case Rep 2018; 4:10. [PMID: 29362998 PMCID: PMC5780336 DOI: 10.1186/s40792-018-0418-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 01/15/2018] [Indexed: 11/12/2022] Open
Abstract
We herein report a 50-year-old Japanese woman with breast cancer who complained of blurred vision and central scotoma in her left eye on the 12th day after surgery. Subsequently, the sudden-onset binocular visual disorder progressed, and she was diagnosed with cancer-associated retinopathy (CAR) based on the clinical findings. Although her visual acuity temporarily improved following the start of adjuvant chemotherapy, reductions in her visual acuity progressed once again. After two courses of steroid pulse therapy initiated from the 59th day following the onset of CAR, although her visual field was still constricted, her binocular visual acuity improved from finger movement to 0.8 2 months later. The shorter the period from onset to treatment, the better the prognosis of the visual function. However, a diagnosis is often delayed because the incidence of this disease is very rare. Therefore, it is important to suspect CAR whenever a sudden visual disorder develops in cancer patients. Furthermore, treatment is believed to be effective even if steroid therapy is started up to 2 months from onset.
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Affiliation(s)
- Mirei Kamei
- Department of Surgery, Tsurumi Hospital, 4333 Tsurumi, Beppu, Oita, 874-8585, Japan.
| | - Yutaka Fujitomi
- Department of Surgery, Tsurumi Hospital, 4333 Tsurumi, Beppu, Oita, 874-8585, Japan
| | - Yoshiyuki Kondo
- Department of Pathology, Tsurumi Hospital, 4333 Tsurumi, Beppu, Oita, 874-8585, Japan
| | - Toru Adachi
- Department of Ophthalmology, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5503, Japan
| | - Kohei Shibata
- Department of Surgery, Tsurumi Hospital, 4333 Tsurumi, Beppu, Oita, 874-8585, Japan
| | - Yohei Takumi
- Department of Thoracic and Breast Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5503, Japan
| | - Miyuki Abe
- Department of Surgery, Tsurumi Hospital, 4333 Tsurumi, Beppu, Oita, 874-8585, Japan
| | - Kenji Sugio
- Department of Thoracic and Breast Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5503, Japan
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15
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Roels D, Ueno S, Talianu CD, Draganova D, Kondo M, Leroy BP. Unilateral cancer-associated retinopathy: diagnosis, serology and treatment. Doc Ophthalmol 2017; 135:233-40. [PMID: 28815346 DOI: 10.1007/s10633-017-9605-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Accepted: 07/31/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE To report a case of unilateral cancer-associated retinopathy (CAR) with clinical, serological and electroretinogram (ERG) normalization after aggressive cancer treatment combined with steroids and rituximab. METHODS Work-up included extensive clinical and electrophysiological testing. Also, serological work-up for antiretinal antibodies and oncological screening was organized. RESULTS A 45-year-old female presented with progressive photopsias, photophobia and relative central scotoma in the right eye since 6 weeks prior. BCVA was 1.0 in both eyes. Biomicroscopy, IOP and fundus exam were unremarkable. Also, colour vision, autofluorescence imaging, OCT and EOG were normal. Visual fields showed decreased central sensitivity in the right eye. ERG showed a unilateral, electronegative combined and ON-bipolar response. A diagnosis of CAR was suspected. After a diagnosis of an adenocarcinoma of the right ovary, radical ovariectomy and hysterectomy were performed, followed by adjuvant chemotherapy. A whole-body PET scan revealed no metastasis. Treatment with rituximab monoclonal antibodies in combination with corticosteroids was initiated. The patient tested positive for serum autoantibodies against TRPM1, a transient receptor potential cation channel expressed in ON-bipolar cells. During treatment, there was progressive improvement in symptoms and the ERG normalized. Serology confirmed complete clearance of autoantibodies. CONCLUSIONS Although rare, unilateral CAR does occur and in cases with high clinical suspicion an oncological work-up is mandatory. Aggressive cancer treatment combined with steroids and rituximab can lead to normalization of the clinical and ERG phenotype, with clearing of antiretinal antibodies.
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16
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Chen FK, Chew AL, Zhang D, Chen SC, Chelva E, Chandrasekera E, Koay EMH, Forrester J, McLenachan S. Acute progressive paravascular placoid neuroretinopathy with negative-type electroretinography in paraneoplastic retinopathy. Doc Ophthalmol 2017; 134:227-235. [PMID: 28382556 PMCID: PMC5427140 DOI: 10.1007/s10633-017-9587-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 03/30/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE Paraneoplastic retinopathy can be the first manifestation of systemic malignancy. A subset of paraneoplastic retinopathy is characterized by negative-type electroretinography (ERG) without fundus abnormality. Here we describe the multimodal imaging and clinico-pathological correlation of a unique case of acute progressive paravascular placoid neuroretinopathy with suspected retinal depolarizing bipolar cell dysfunction preceding the diagnosis of metastatic small cell carcinoma of the prostate. METHODS ERG was performed according to the International Society for Clinical Electrophysiology of Vision standards. Imaging modalities included near-infrared reflectance, blue-light autofluorescence, fluorescein and indocyanine green angiographies, spectral domain optical coherence tomography, ultra-widefield colour and green-light autofluorescence imaging, microperimetry and adaptive optics imaging. Patient serum was screened for anti-retinal antibodies using western blotting. Immunostaining and histological analyses were performed on sections from human retinal tissues and a patient prostate biopsy. RESULTS Serial multimodal retinal imaging, microperimetry and adaptive optics photography demonstrated a paravascular distribution of placoid lesions characterized by hyper-reflectivity within the outer nuclear layer resembling type 2 acute macular neuroretinopathy. There was no visible lesion within the inner nuclear layer despite electronegative-type ERG. Six months later, the patient presented with metastatic small cell carcinoma of the prostate. Tumour cells were immunopositive for glyceraldehyde-3-phosphate dehydrogenase, enolase and recoverin as well as neuroendocrine markers. The patient's serum reacted to cytoplasmic and nuclear antigens in the prostate biopsy and in human retina. Anti-retinal antibodies against several antigens were detected by both commercial and in-house western blots. CONCLUSIONS A spectrum of autoreactive anti-retinal antibodies is associated with a unique phenotype of acute progressive paravascular placoid neuroretinopathy resulting in degeneration of photoreceptor cells, inner retinal dysfunction and classic electronegative ERG in paraneoplastic retinopathy. Detailed clinical, functional and immunological phenotyping of paraneoplastic retinopathy illustrated the complex mechanism of paraneoplastic syndrome.
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Affiliation(s)
- Fred K Chen
- Centre for Ophthalmology and Vision Science, The University of Western Australia, Perth, WA, Australia.,Lions Eye Institute, Perth, WA, Australia.,Department of Ophthalmology, Royal Perth Hospital, Perth, WA, Australia
| | - Avenell L Chew
- Centre for Ophthalmology and Vision Science, The University of Western Australia, Perth, WA, Australia.,Lions Eye Institute, Perth, WA, Australia
| | - Dan Zhang
- Lions Eye Institute, Perth, WA, Australia
| | | | - Enid Chelva
- Department of Medical Technology and Physics, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | | | - Eleanor M H Koay
- PathWest Laboratory Medicine WA, Fiona Stanley Hospital, Perth, WA, Australia
| | - John Forrester
- Centre for Ophthalmology and Vision Science, The University of Western Australia, Perth, WA, Australia.,Lions Eye Institute, Perth, WA, Australia.,The Institute of Medical Sciences, The University of Aberdeen, Scotland, UK
| | - Samuel McLenachan
- Centre for Ophthalmology and Vision Science, The University of Western Australia, Perth, WA, Australia. .,Lions Eye Institute, Perth, WA, Australia. .,Department of Ophthalmology, Royal Perth Hospital, Perth, WA, Australia. .,Ocular Tissue Engineering Laboratory, Lions Eye Institute, 2 Verdun Street, Nedlands, WA, 6009, Australia.
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17
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Suimon Y, Saito W, Hirooka K, Kanda A, Kitai H, Sakakibara-Konishi J, Ishida S. Improvements of visual function and outer retinal morphology following spontaneous regression of cancer in anti-recoverin cancer-associated retinopathy. Am J Ophthalmol Case Rep 2017; 5:137-140. [PMID: 29503967 PMCID: PMC5758029 DOI: 10.1016/j.ajoc.2016.12.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 12/17/2016] [Accepted: 12/29/2016] [Indexed: 12/02/2022] Open
Abstract
Purpose To report an anti-recoverin antibody-positive cancer-associated retinopathy (anti-recoverin CAR) patient with remarkable improvements of visual function and outer retinal morphology following spontaneous regression of cancer. Observations A 65-year-old woman with small cell lung carcinoma developed progressive, bilateral vision loss with diffuse loss of the ellipsoid zone at the macula on optical coherence tomography and marked reduced responses of a- and b-waves on electroretinography. Western blot analysis led to a diagnosis of anti-recoverin CAR. The visual function and outer retinal morphology gradually improved following spontaneous regression of the cancer and the initiation of systemic corticosteroid. Subsequent intermittent chemotherapy and continuation of corticosteroid maintained reduction of the cancer and prevented the recurrence of CAR, with preservation of improvements of the visual function and macular outer retinal morphology. Conclusions and importance These results suggest that requirement for obtaining good visual prognosis in CAR patients is to make the cancer regress prior to falling into photoreceptor apotosis.
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Affiliation(s)
- Yuka Suimon
- Department of Ophthalmology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Wataru Saito
- Department of Ophthalmology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kiriko Hirooka
- Department of Ophthalmology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Atsuhiro Kanda
- Department of Ophthalmology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Hidenori Kitai
- First Department of Medicine, Hokkaido University School of Medicine, Sapporo, Japan
| | | | - Susumu Ishida
- Department of Ophthalmology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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18
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Abstract
We write to report a rare case of unilateral cancer-associated retinopathy previously undocumented in the literature. Cancer-associated retinopathy is an uncommon paraneoplastic syndrome. It is characterised by retinal antigen autoantibodies causing rod and cone dysfunction and abnormal electroretinography findings with consequent progressive visual loss.Our patient, known to have a primary cervical intraepithelial neoplasia, presented with unilateral blurred vision as well as a disturbance in colour and night vision. Electroretinography findings of reduced a and b waves in the right eye, together with a fundoscopic appearance of a mottled retinal pigment epithelium, attenuated blood vessels and optic disc pallor were consistent with unilateral cancer-associated retinopathy. Posterior subtenon injections of triamcinolone were administered to control active disease. With periocular steroid injections, at 4 years, our patient's visual acuity remained relatively stable and her condition persisted strictly unilaterally. Cancer-associated retinopathy may be the first presenting sign of an underlying malignancy or may indicate its recurrence. Moreover, in patients with a diagnosed gynaecological malignancy, visual symptoms could reflect cancer-associated retinopathy. In our patient visual symptoms came secondary to the diagnosis of cancer.
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Affiliation(s)
| | | | - Ayad Al-Bermani
- Consultant Medical Ophthalmologist and Honorary Lecturer, Cardiff Eye Unit, University hospital of Wales, UK
| | - Gareth Payne
- Consultant, Medical Physics Department, University Hospital of Wales, UK
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Nakamura T, Fujisaka Y, Tamura Y, Tsuji H, Matsunaga N, Yoshida S, Imanishi M, Fujita K, Ikeda S, Oku H, Goto I, Ikeda T, Hanafusa T. Large cell neuroendocrine carcinoma of the lung with cancer-associated retinopathy. Case Rep Oncol 2015; 8:153-8. [PMID: 25873883 PMCID: PMC4386109 DOI: 10.1159/000380943] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We report a rare case of large cell neuroendocrine carcinoma (LCNEC) of the lung with cancer-associated retinopathy (CAR). To our knowledge, only two cases of LCNEC with CAR have been reported, one in 1995 and another in 2013. CAR, typically associated with small cell lung cancer (SCLC), is one of the paraneoplastic syndromes with deterioration of visual acuity, visual field constriction, and photophobia. CAR is caused by an autoimmune system reaction against the same antigen in the tumor and retinal photoreceptor cells. To diagnose CAR, genetic retinal dystrophies or any other medical causes of retinopathy should be excluded, but there are no standard diagnostic criteria. Anti-retinal antibodies are known to be positive in CAR patients, and anti-recoverin antibodies are thought to be sensitive and specific to CAR. In our case, anti-recoverin antibodies were not detected by serum tests, but CAR could be diagnosed on the basis of ophthalmological findings including clinical symptoms, electroretinographic findings, and visual field tests. CAR with clinical features of rapid visual disorder should be considered in LCNEC patients as well as in SCLC patients.
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Affiliation(s)
- Takahiko Nakamura
- Department of Internal Medicine (I), Osaka Medical College Hospital, Osaka, Japan
| | - Yasuhito Fujisaka
- Department of Clinical Research Center, Osaka Medical College Hospital, Osaka, Japan ; Department of Cancer Center, Osaka Medical College Hospital, Osaka, Japan
| | - Yosuke Tamura
- Department of Internal Medicine (I), Osaka Medical College Hospital, Osaka, Japan
| | - Hiroyuki Tsuji
- Department of Internal Medicine (I), Osaka Medical College Hospital, Osaka, Japan
| | - Ninso Matsunaga
- Department of Internal Medicine (I), Osaka Medical College Hospital, Osaka, Japan
| | - Shuhei Yoshida
- Department of Internal Medicine (I), Osaka Medical College Hospital, Osaka, Japan
| | - Masafumi Imanishi
- Department of Internal Medicine (I), Osaka Medical College Hospital, Osaka, Japan
| | - Kazuhiko Fujita
- Department of Internal Medicine (I), Osaka Medical College Hospital, Osaka, Japan
| | - Soichiro Ikeda
- Department of Internal Medicine (I), Osaka Medical College Hospital, Osaka, Japan
| | - Hidehiro Oku
- Department of Ophthalmology, Osaka Medical College, Osaka Medical College Hospital, Osaka, Japan
| | - Isao Goto
- Department of Internal Medicine (I), Osaka Medical College Hospital, Osaka, Japan
| | - Tsunehiko Ikeda
- Department of Ophthalmology, Osaka Medical College, Osaka Medical College Hospital, Osaka, Japan
| | - Toshiaki Hanafusa
- Department of Internal Medicine (I), Osaka Medical College Hospital, Osaka, Japan
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20
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Sampedro A, Carballo C, Barbón JJ, Andrés A, Viña C, Abelairas V. [Ocular paraneoplastic syndrome: cancer-associated retinopathy]. ACTA ACUST UNITED AC 2013; 88:407-9. [PMID: 24060306 DOI: 10.1016/j.oftal.2012.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2010] [Revised: 12/09/2011] [Accepted: 06/10/2012] [Indexed: 11/17/2022]
Abstract
CASE REPORT We review a patient with ocular manifestations of a paraneoplastic syndrome. It was a cancer-associated retinopathy (CAR) in a woman with visual loss, and attenuated and sheathed retinal arterioles. The electroretinography (ERG) showed severe abnormalities of the a and b-waves. The tumour process was not discovered until 6 months later, when a squamous neoplasia that invaded the uterus and vagina was observed. DISCUSSION Paraneoplastic syndromes are a group of manifestations produced as a remote effect of cancer cells. CAR syndrome is caused by autoimmune reactions to retinal antigens induced by aberrant expression of recoverin in cancer tissues. Ophthalmologists must be aware of ocular paraneoplastic signs as they can be the first manifestations of a malignant tumour.
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Affiliation(s)
- A Sampedro
- Servicio de Oftalmología, Hospital San Agustín, Avilés, Asturias, España.
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Kim JH, Kim JH, Kim DH, Park WY, Kim KW, Yu YS. Intravenously administered anti-recoverin antibody alone does not pass through the blood-retinal barrier. Korean J Ophthalmol 2011; 25:189-95. [PMID: 21655045 PMCID: PMC3102823 DOI: 10.3341/kjo.2011.25.3.189] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Accepted: 12/27/2010] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Cancer-associated retinopathy is a paraneoplastic retinal degeneration which may primarily result from auto-immune mediated apoptosis. It has been hypothesized that high titer of auto-antibodies are able to cross the blood-retinal barrier (BRB) and to enter retinal cells to activate apoptotic pathway which has been already well-established. However, it still remains to be elucidated whether auto-antibodies could cross BRB in the retina. Herein, we demonstrated that intravenously administrated anti-recoverin antibodies could not pass through BRB and not lead to retinal cell death. METHODS Anti-recoverin antibody was intravenously injected to C57BL/6 mice, which were sacrificed 1 and 7 days to obtain eye. Vascular endothelial growth factor was intravitreally injected to induce BRB breakdown, which was confirmed by fluorescein angiography and western blotting for zonula occludens (ZO)-1, ZO-2 and occludin. To investigate the location of anti-recoverin antibody in the retina, immunofluorescein was performed. The retinal toxicity of intravenous anti-recoverin antibody was evaluated by histological examination and transferase-mediated dUTP nick-end labeling. Immunofluorescein staining for glial fibrillary acidic protein was done to address glial activation as well. RESULTS Intravenously administrated anti-recoverin antibodies were exclusively distributed on retinal vessels which were co-localized with CD31, and led to neither increase of glial fibrillary acidic protein expression, as an indicator of retinal stress, nor apoptotic retinal cell death. Moreover, even in the condition of vascular endothelial growth factor-induced BRB breakdown, anti-recoverin antibodies could not migrate across BRB and still remained on retinal vessels without retinal cytotoxicity. CONCLUSIONS Our results suggest that high titer of intravascular anti-recoverin antibodies could not penetrate into the retina by themselves, and BRB breakdown mediated by dysregulation of tight junction might not be sufficient to allow anti-recoverin antibodies to pass through BRB.
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Affiliation(s)
- Jeong Hun Kim
- Fight against Angiogenesis-Related Blindness Laboratory, Department of Ophthalmology, Seoul National University College of Medicine & Seoul Artificial Eye Center, Clinical Research Institute, Seoul National University Hospital, Seoul, Korea
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