Cancer-associated retinopathy after surgery for breast cancer: a case report and review of the literature

Abstract

We herein report a 50-year-old Japanese woman with breast cancer who complained of blurred vision and central scotoma in her left eye on the 12th day after surgery. Subsequently, the sudden-onset binocular visual disorder progressed, and she was diagnosed with cancer-associated retinopathy (CAR) based on the clinical findings. Although her visual acuity temporarily improved following the start of adjuvant chemotherapy, reductions in her visual acuity progressed once again. After two courses of steroid pulse therapy initiated from the 59th day following the onset of CAR, although her visual field was still constricted, her binocular visual acuity improved from finger movement to 0.8 2 months later. The shorter the period from onset to treatment, the better the prognosis of the visual function. However, a diagnosis is often delayed because the incidence of this disease is very rare. Therefore, it is important to suspect CAR whenever a sudden visual disorder develops in cancer patients. Furthermore, treatment is believed to be effective even if steroid therapy is started up to 2 months from onset.

Central retinal vein occlusion in a patient with breast carcinoma

“…Besides, when a metastatic tumor in the optic nerve causes compression, venous outflow channels are impeded and CRVO could occur [ 12 ]. The other rare paraneoplastic syndrome in carcinoma that can cause vision loss is cancer-associated retinopathy (CAR) [ 13 ], [ 14 ]. Unlike CRVO, which presents with striking retinal hemorrhages, the clinical picture in CAR is rather subtle.…”

Ocular Paraneoplastic Syndromes: A Critical Review of Diffuse Uveal Melanocytic Proliferation and Autoimmune Retinopathy

“…The results have been mixed in terms of short-term outcomes. 71,81-105 Since 2012, there have been 40 cases reported with extractable information (Table, supplement). Among those patients, 25 (62.5%) had more than 3 months of follow-up.…”

Ocular Paraneoplastic Syndromes

“…This results in symptoms of cone dysfunction, namely, photosensitivity as well as photopsias (type of visual hallucinations seen as light flashes), prolonged glare, decreased best-corrected visual acuity (BCVA), color discrimination or disturbed color vision, and central scotomas. Rod dysfunction may include night blindness, prolonged adaptation to darkness, and peripheral or ring scotomas [ 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 ].…”

“…Central or ring scotomas should be detected in visual field examination. In electroretinography (ERG), rod- and cone-mediated responses are not recordable or significantly decreased, firstly affecting the a-wave and subsequently lining rapidly to a “flat ERG” [ 8 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ].…”