Author: yanchun Zhang (China)
Co-authors: Binxuan Qin, Ziwei Kang, Linna Hao
Purpose
Cancer associated retinopathy (CAR) is a rare cause of painless vision loss, associated with an underlying systemic malignancy. It usually damages photoreceptors and causes acute/subacute vision loss and visual field defects but seldom vitreous opacity. This report describes the case of a 71-year-old Chinese woman with binocular visual disturbance and vitreous opacity as the first symptom. She was subsequently diagnosed with thyroid papillary carcinoma.
Setting/Venue
Xi’an People’s Hospital (Xi'an Fourth Hospital), Affiliated Guangren Hospital, School of Medicine, Xi’an Jiaotong University, Xi'an Ocular Fundus Disease Research Institute, Xi’an, 710004, China
Methods
The patient had painless, blurred vision for 1 year without redness. She denied any history of other diseases. Best-corrected visual acuity was 0.5 (10/20) OU. Anterior segment were within normal limits. Dilated fundus examination demonstrated bilateral vitreous opacity with gray cells. Both fundus were without bleeding or exudation; FA showed faint leakage of the small vessels; The aqueous humor IL-10 , IL-6 were 0 pg/ml. Tuberculosis, syphilis, immunodeficiency were excluded; Her blood, HbAlc, Liver and renal functions, head MRI were normal. Chest CT showed multiple nodules in lungs, abdominal B-ultrasound scan showed liver cysts. Recoverin antibody and tumor-related antigens were negative. 3 months later, both eyes’ vision declined to 0.3 (6/20) OD and 0.25 (5/20) OS, and vitreous opacity aggravated. The patient’s symptom improved after using glucocorticoids on both eyes. But 2 months later, the symptoms worsened again, and she felt that the occlusion was obvious in the left eye. Scattered yellow-white spots besided blood vessels could be seen on the right fundus and the left fundus was blurred. OCT showed loss of IS/OS junction, subretinal hyper-reflective foci and ONL thin in peripheral macula. The ERG showed rod and cone responses severely decreased. Both eyes showed peripheral visual field defects.
Results
Advanced systemic examination performed and papillary thyroid carcinoma in the right lobe and isthmus was confirmed by pathological examination. The patient accepted PPV on the left eye because she could not tolerate the obvious occlusion. The vitreous biopsy showed no obvious atypical lymphocytes, and the postoperative visual acuity was improved to 0.6 (12/20). The patient had clinical features of CAR, such as progressive loss of vision, retinal vasculitis, photoreceptors damages, visual field defects, abnormal ERG, and subsequently diagnosed with thyroid papillary carcinoma. All of these support the diagnosis of CAR. this case is special with vitreous body turbidity obviously and transient perivascular scattered yellowish-white spot, sarcomatoid lesions in lung and liver which seems as paraneoplastic sarcoid-like reactions.
Conlusions
CAR is a rare disease caused by the distant effect of the primary malignant tumor. But CAR seldom appears with vitreous opacity. This case shows an unusual vitreous opacity with CAR complicated by papillary thyroid carcinoma.
Financial Disclosure
No
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