title: Bilateral paraneoplastic optic neuropathy and unilateral retinal compromise in association with prostate cancer: a differential diagnostic challenge in a patient with unexplained visual loss.
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.
authors.affiliation: 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.
authors.forename: Giovannella
authors.initials: G
authors.lastname: Carboni
authors.forename: Gina
authors.initials: G
authors.lastname: Forma
authors.forename: April D
authors.initials: AD
authors.lastname: Bond
authors.forename: Grazyna
authors.initials: G
authors.lastname: Adamus
authors.forename: Alessandro
authors.initials: A
authors.lastname: Iannaccone
mesh_terms: D000368:Aged; D001323:Autoantibodies / Q000097:blood; D001324:Autoantigens / Q000276:immunology; D015153:Blotting, Western; D003937:Diagnosis, Differential; D004596:Electroretinography; D005074:Evoked Potentials, Visual / Q000502:physiology; D005451:Fluorescein Angiography; D006801:Humans; D008297:Male; D009900:Optic Nerve / Q000276:immunology; D009901:Optic Nerve Diseases / Q000175:diagnosis* / Q000276:immunology / Q000503:physiopathology; D059545:Paraneoplastic Syndromes, Ocular / Q000175:diagnosis* / Q000276:immunology / Q000503:physiopathology; D011471:Prostatic Neoplasms / Q000473:pathology*; D012160:Retina / Q000276:immunology; D015356:Retinal Artery Occlusion / Q000175:diagnosis*; D041623:Tomography, Optical Coherence; D014786:Vision Disorders / Q000175:diagnosis*; D014792:Visual Acuity / Q000502:physiology; D058609:Visual Field Tests; D014794:Visual Fields / Q000502:physiology
chemical_list: D001323:Autoantibodies; D001324:Autoantigens