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Paraneoplastic retinopathy with multiple detachments of the neurosensory retina and autoantibodies against interphotoreceptor retinoid binding protein (IRBP) in cutaneous melanoma
  1. Carlos Bianciotto1,
  2. Carol L Shields1,
  3. Charles E Thirkill2,
  4. Miguel A Materin1,
  5. Jerry A Shields1
  1. 1Ocular Oncology Service, Wills Eye Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
  2. 2Ocular Immunology Laboratory, University of California, California, Davis, California, USA
  1. Correspondence to Dr Carol L Shields, Ocular Oncology Service, Suite 1440, Wills Eye Institute, 840 Walnut Street, Philadelphia, PA 19107, USA; carol.shields{at}

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Case description

A 74-year-old Caucasian man developed gradual bilateral visual loss over 3 months. He had bilateral chronic open-angle glaucoma treated with trabeculectomy. Past medical history included cutaneous melanoma of the face and neck excised 14 months earlier. The patient then developed brain metastasis treated with external beam radiotherapy 6 months prior and liver, axillary lymph nodes and lung metastasis treated with systemic chemotherapy 3 months earlier.

On ocular examination, best corrected visual acuities were 20/70 in the right eye (OD) and 20/60 in the left eye (OS). Intraocular pressures were 10 mm Hg in both eyes. Slit-lamp examination showed bilateral filtering blebs, mild nuclear sclerotic cataract OD and intraocular lens OS. Funduscopy revealed three serous detachments of the neurosensory retina in the macula OD measuring 2–3 mm in basal diameter. Six similar lesions were found in the posterior pole of OS ranging from 1 to 2 mm in diameter. There were no choroidal metastases. Optical coherence tomography (OCT) documented numerous serous detachments of the neurosensory retina in each eye (figure 1). Fullfield electroretinogram (ERG) analysing cone and rod function separately was normal. Electro-oculogram (EOG) was not obtained due to patient preference (figure 2).

Figure 1

(A) Fundus photograph of the right eye showing subtle retroequatorial detachments of the neurosensory retina. (B) Autofluorescence of the right eye demonstrating ring hyperautofluorescence on the margin of each serous detachment of the neurosensory retina. (C) Optical coherence tomography of the right eye showing subfoveal detachment of the neurosensory retina.

Figure 2

(A) Fundus photograph of the left eye with multiple …

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  • Funding Support provided by the Retina Research Foundation of the Retina Society in Cape Town, South Africa (CLS); the Paul Kayser International Award of Merit in Retina Research, Houston TX (JAS); a donation from Michael, Bruce and Ellen Ratner, New York (JAS, CLS); Mellon Charitable Giving from the Martha W Rogers Charitable Trust, Philadelphia, PA (CLS); the LuEsther Mertz Retina Research Foundation, New York (CLS); and the Eye Tumor Research Foundation, Philadelphia, PA (CLS, JAS). Research to Prevent Blindness (RPB), and NEI core grant 1 P30 EY12576-4 (CET).

  • Patient consent Obtained.

  • Ethics approval Ethics approval was provided by the UC Davis IRB and Wills Eye Institute.

  • Provenance and peer review Not commissioned; externally peer reviewed.