Clinical And SD-OCT Characterization Of Paraneoplastic Retinopathy

Objective: As a spectrum of relatively rare and secondary retinopathy to primary malignancies, paraneoplastic retinopathy(PR) consists of many secondary retinal dysfunctions. The symptoms of PR include versatile complaints. Whilst there doesn’t exist definite diagnosis criteria, mechanism and treatment for PR.PRs include cancer-associated retinopathy(CAR), melanoma-associated retinopathy(MAR) and lymphoma-associated retinopathy(LAR). The developments and mechanisms of PR varies from each other a lot. But the most believable hypothesis is the autoantibodies against common proteins expressed by malignant cells and retinal cells. While recent researches about the autoantibodies aren’t optimistic, PRs not always have serum auto-antibodies and normal controls can also have autoantibodies.Sawyer were the first to describe PR in 1976. Then Gass observed the first case with MAR. The primary tumor of PRs can be lung carcinoma, breast cancer, melanoma, lymphoma, prostatic carcinoma, ovarian cancer, colorectal carcinoma, retroperitoneal pimeloma, or seminoma. As the symptoms of primary malignancies are more symptomatic and severer, the ocular complaints can be occult and mild enough to be neglected by PRs. So the diagnosis rate of PR can be under-estimated.The existence of anti-retinal antibodies is necessary, but not always essential. Diagnostic tests for serum autoantibodies are hampered by lack off standardization and unknown predictive value of a positive test. With spectral-domain optical coherence tomography(SD-OCT), we can investigate each details of retinal layers. Whilst the reports of OCT observations on PRs are not very sufficient.Our study aims at the investigation of clinical and SD-OCT characteristics of PRs, and the we are determined to clarifying the mechanism of PR, and to providing more details of retinal changes in PRs.Methods:1 Between Aug 1st, 2013 and Feb 1st,2015, 5 PRs were diagnosed and the medical data of them were collected( including best corrected visual acuity(BCVA), fluorescein angiography(FFA), electroretinography( ERG) and SD-OCT).2 The observed measurements: the existence and concentration of anti-retinal antibodies, BCVA, and characteristics of FFA, ERG and SD-OCT.3 Analysis of the collected data: SPSS 17.0(SPSS for Windows, version 17.0, SPSS, Chicago, IL) was used to analyze collected data. As the sample size is small, we only described the details of the 5 PRs, without analysis of the correlations among the measured index.Results:Four of 5 PRs had cancer medical history(small cell lung carcinoma, prostatic carcinoma, colorectal carcinoma and lymphoma), and 1 PR with newly diagnosed small cell lung carcinoma. Three of the 5 subjects were male. The mean age of the 5 PRs was 72±9.9 years( from 56 years old to 78 years old). BCVA of 5 PRs ranged from hand motion to 1.0. Fluorescein leakage was noticed in 4 cases. Two patients had significantly reduced amplitude ERG. Outer retina server damages were observed with SD-OCT in 2 cases, whose serum were anti-photoreceptor positive. Anti- retinal pigment epithelial autoantibody was positive in 1 patient.Conclusion:We notice the heterogeneity of the primary malignancies and autoantibodies. SD-OCT is of great help in observing the retinal damage of PRs. The relationship between anti-retinal antibodies and retinal damages needs further investigation.