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

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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 paraneoplastic manifestation than CAR and it is rarely observed in association with prostate cancer. A combination of visual function testing methods permitted the recognition, in this highly unusual case, of the concurrent presence of unilateral ERG changes most likely attributable to CRAO complications in OS, in all likelihood unrelated to CAON, and not to be confused with unilateral CAR. Auto-Ab testing in combination with visual function tests helps achieve a better understanding of the pathophysiology of vision loss in paraneoplastic visual syndromes.

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Author notes

  1. Giovannella Carboni & Gina Forma

    Present address: Institute of Ophthalmology, S. Giovanni di Dio Hospital, University of Cagliari, Cagliari, Italy

  2. April D. Bond

    Present address: Medtronic Corp., Memphis, TN, USA

Authors and Affiliations

  1. Retinal Degeneration and Ophthalmic Genetics Service, Department of Ophthalmology, Hamilton Eye Institute, University of Tennessee Health Science Center, 930 Madison Avenue, Suite 731, Memphis, TN, 38163, USA

    Giovannella Carboni, Gina Forma, April D. Bond & Alessandro Iannaccone

  2. Ocular Immunology Laboratory, Casey Eye Institute, Oregon Health and Science University, Portland, OR, USA

    Grazyna Adamus

Authors
  1. Giovannella Carboni
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  2. Gina Forma
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  3. April D. Bond
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  4. Grazyna Adamus
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  5. Alessandro Iannaccone
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Correspondence to Alessandro Iannaccone.

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Carboni, G., Forma, G., Bond, A.D. et al. Bilateral paraneoplastic optic neuropathy and unilateral retinal compromise in association with prostate cancer: a differential diagnostic challenge in a patient with unexplained visual loss. Doc Ophthalmol 125, 63–70 (2012). https://doi.org/10.1007/s10633-012-9327-0

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  • DOI: https://doi.org/10.1007/s10633-012-9327-0

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