Ophthalmic Images

Abstract

Comment. Cancer-associated retinopathy is most commonly associated with small cell carcinoma of the lung. Cases have also been reported in patients with breast, cervical, uterine, and endometrial carcinoma. An autoimmune mechanism against retinal antigens, including recoverin and enolase, has been proposed. Antibodies against recoverin (a calcium-binding protein found in retinal photoreceptor cells) may activate cell apoptotis via a calcium-dependent pathway leading to retinal degeneration with loss of photoreceptor outer segments and outer nuclear layers seen on histopathology. Cancer-associated retinopathy with antirecoverin antibodies is associated with severe, progressive visual loss and profound abnormalities seen on electroretinography. Various treatments, including systemic steroids, plasmapheresis, and calcium channel blockers, have been tried with little success. Visual symptoms often precede diagnosis of malignancy, and prompt recognition can help identification and treatment at an earlier stage. In our case, OCT showed dramatic thinning of the retina with loss of the inner, highly reflective layer corresponding to the histopathologic changes described. Reduced macular thickness on OCT can be demonstrated acutely in CAR prior to severe visual loss. Optical coherence tomography is a useful noninvasive test in patients with unexplained visual loss and may provide an objective measure of retinal damage in these patients.