Bilateral paraneoplastic optic neuropathy and unilateral retinal compromise in association with prostate cancer: a differential diagnostic challenge in a patient with unexplained visual loss.

Documenta Ophthalmologica. Advances in Ophthalmology
Giovannella CarboniAlessandro Iannaccone

Abstract

We report a 77-year-old Caucasian man with a 1-year complaint of unexplained visual loss and a 4-year history of prostate cancer. A complete ophthalmologic exam, Goldmann visual fields (GVFs), intravenous fluorescein angiography (IVFA), macular and disc optical coherence tomography (OCT), pattern-reversal visual evoked potentials (PVEPs), and flash electroretinograms (ERGs) were performed. On examination, visual acuity was reduced bilaterally. Fundus exam showed juxtapapillary changes (OS > OD) and, in OS, disc pallor, peripheral RPE dropout and whitish retinal discoloration along the arcades. OCTs were normal OU. Cancer-associated retinopathy (CAR) was suspected. A flash ERG was normal OD and markedly reduced and electronegative OS. An IVFA showed bilateral juxtapapillary staining and changes highly suggestive of sequelae of central retinal artery occlusion (CRAO) OS , in which a cilioretinal artery existed along the papillomacular bundle. GVFs showed bilateral blind spot enlargement and centrocecal scotomas, and PVEPs were delayed. These findings suggested cancer-associated optic neuropathy (CAON), confirmed by presence of anti-optic nerve autoantibodies (auto-Abs). No anti-retinal auto-Abs were found. CAON is a less common p...Continue Reading

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Aug 24, 2013·Survey of Ophthalmology·Ehsan Rahimy, David Sarraf
Oct 10, 2013·Ocular Immunology and Inflammation·Yi Cai, Jose S Pulido
Jun 5, 2013·Ocular Immunology and Inflammation·Merih OrayIlknur Tugal-Tutkun
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Jun 5, 2019·Molecules : a Journal of Synthetic Chemistry and Natural Product Chemistry·Yinchun Jiao, Frank Weinhold
Feb 18, 2014·Optometry and Vision Science : Official Publication of the American Academy of Optometry·Kristen MoyerCandice Law

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