Stabilization of Visual Field With Intravitreal Triamcinolone in Cancer-Associated Retinopathy: A Case Report and Review of the Literature

Justin Yamanuha,Misty Watters

doi:10.26502/ami.93650017

Abstract

A 53 year old male with leukemia presented with optic disc pallor, attenuated retinal vessels and peripheral visual field loss confirmed on formal testing. Anti-retinal antibodies were detected by immunohistochemistry confirming the diagnosis of cancer- associated retinopathy (CAR). Hematology continued systemic chemotherapy but did not recommend systemic immune suppression as a safe treatment for the paraneoplastic eye disease. The patient received a single injection in the more severely affected eye of intravitreal triamcinolone and had initial improvement then ultimately stabilization of the visual field loss and optic nerve pallor without any side effects from the intraocular steroid injection. This case demonstrates that intraocular corticosteroid can be a safe, efficacious, local treatment option for cancer associated retinopathy.

Highlights

Cancer-associated retinopathy (CAR) is a challenging clinical entity with often delayed diagnosis and difficult prognosis
Treatment and Results Alternative treatment options for cancer-associated retinopathy were reviewed with the patient and included intraocular corticosteroid injections as used previously in anecdotal case reports [1, 2]
Over the several months, the patient had improved systemic health requiring less frequent intravenous immune globulin infusions for his hypo-gammaglobulinemia. He did not receive any further intraocular corticosteroid injections and had only mild regression of visual field loss in the treated left eye (Figure 6) with maintained visual acuity to near baseline (20/30 in the right eye and 20/50 in the left eye). This case demonstrates the utility of intravitreal triamcinolone injections as a treatment option for cancer-associated retinopathy and a reminder of its finite duration of action

Summary

Introduction

Cancer-associated retinopathy (CAR) is a challenging clinical entity with often delayed diagnosis and difficult prognosis. The condition occurs in patients with typically known systemic malignancy but can precede cancer diagnosis. The clinical phenotype is varied, but typically includes optic nerve pallor, retinal vascular attenuation and visual field loss in the absence of obvious peripheral retinal abnormalities. Even with treatment of the systemic malignancy, the prognosis typically involves worsening visual field loss. Anecdotal reports of intravitreal (intraocular) steroid injections have been able to demonstrate stability of visual field loss. This case report details the course of a patient with serologically confirmed cancer- associated retinopathy who showed initial improvement and later stabilization of visual acuity, optic nerve structure and function after a single intravitreal steroid injection in one eye

Methods

Results

Conclusion