Clinical and immunologic aspects of cancer-associated retinopathy

doi:10.1016/j.ajo.2004.01.010

American Journal of Ophthalmology

Volume 137, Issue 6, June 2004, Pages 1117-1119

https://doi.org/10.1016/j.ajo.2004.01.010 Get rights and content

Abstract

Purpose

To report clinical and immunologic aspects of cancer-associated retinopathy (CAR).

Design

Observational consecutive case series.

Methods

A retrospective review was made of 18 consecutive patients with cancer-associated retinopathy who had antiretinal antibody determination by Western blot testing.

Results

Clinically, a variety of ophthalmic observations including electroretinography impairment, retinal vessel narrowing, deterioration of visual acuity, visual field changes, and uveitis were frequently observed. As retinal autoantigens in the 18 cases, recoverin was found in all 18 cases (100%), heat shock cognate protein 70 (HSC70) was found in six cases (33%), and other proteins were found in four cases (20%). These antibodies were detected in only 60% of the patients at the initial examination, however, and then became increasingly apparent on the subsequent testing that was performed three times on serum samples obtained sequentially during the following months.

Conclusion

For diagnosis of cancer-associated retinopathy, the presence of serum autoantibody toward recoverin is essentially required in addition to the characteristic clinical aspects noted above.

References (5)

H Ohguro et al.
Pathological roles of recoverin in cancer-associated retinopathy
Adv Exp Med Biol
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D.M Jacobson et al.
A clinical triad to diagnose paraneoplastic retinopathy
Ann Neurol
(1990)

There are more references available in the full text version of this article.

Cited by (88)

Treatment of Cancer-Associated Retinopathy: A Systematic Literature Review
2023, Ophthalmology Retina
Systematic literature review of treatment efficacy of previously used protocols in treating patients with proven cancer-associated retinopathy (CAR).
There is no universally accepted treatment algorithm for CAR and visual prognosis is very poor. We describe a patient with CAR with dramatic improvement in vision after treatment with high doses of corticosteroids followed by plasma exchange (PLEX) and present results of a systematic literature review of treatment efficacy of previously used protocols in treating patients with proven CAR.
We describe a 70-year-old man with CAR who demonstrated dramatic improvement in vision after treatment with high doses of systemic corticosteroids followed by 7 sessions of PLEX. We then report the results of a systematic review of all previously published English literature discussing visual outcomes of various treatment regimens used for patients with antibody-proven CAR.
The index patient is a rare case of CAR with sustained significant improvement in vision after treatment with high doses of corticosteroids followed by PLEX. The systematic review identified 28 antibody-proven cases of CAR, 27 of which were treated with steroids, which resulted in varying degrees of improvement in visual acuity in 59% (16 of 27). The time from symptom onset to initiation of treatment and the dose of steroids did not influence the visual outcome. Three patients were also treated with PLEX in addition to steroids, and 2 of 3 patients demonstrated improvement in vision; however, there was no difference in visual outcome in patients treated with steroids only versus those treated with steroids + PLEX.
Treatment with steroids or steroids + PLEX resulted in some improvements in visual acuity in 59% of patients. Removal of antirecoverin antibodies with PLEX can arrest the immune attack on the photoreceptors and potentially improve visual function; thus, it should be considered in addition to steroids. Further studies with larger cohorts are needed to establish a treatment protocol and further determine the effectiveness of the different approaches.
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Occurrence of major anti-retinal autoantibodies associated with paraneoplastic autoimmune retinopathy
2020, Clinical Immunology
Citation Excerpt :
It is characterized by unexplained loss of vision associated with retinal dysfunction/degeneration, distant malignancy, and the presence of serum anti-retinal autoantibodies (AAbs). The most common visual paraneoplastic disorders include cancer-associated retinopathy (CAR) and melanoma–associated retinopathy (MAR) [1–3]. CAR is defined as an autoantibody-driven remote effect of systemic cancer that is associated with retinal degeneration that is not caused by tumor metastasis.
Autoantibodies (AAbs) against retinal antigens can be found in patients with cancer and unexplained vision loss unrelated to the cancer metastasis. Cancer-associated retinopathy (CAR) is a rare paraneoplastic visual syndrome mediated by AAbs. Our goal was to determine whether CAR patients with different malignancies have a specific AAb or repertoire of AAbs that could serve as biomarkers for retinal disease. We found AAbs against 12 confirmed retinal antigens, with α-enolase being the most frequently recognized. The significant finding of the study was a high incidence of anti-aldolase AAbs in colon-CAR, anti-CAII in prostate-CAR, and anti-arrestin in skin melanoma patients thus these AAbs could serve as biomarkers in the context of clinical presentation and could support the diagnosis of CAR. However, a lack of AAb restriction to any one antigenic protein or to one retinal cellular location makes screening for a CAR biomarker challenging.
Visual Loss: Retinal Disorders of Neuro-Ophthalmic Interest
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While a comprehensive review of all retinal disease is beyond the scope of this text, there are several entities that are particularly important in the neuro-ophthalmic differential diagnosis of central and peripheral visual loss and positive visual phenomenon. Patients with retinopathies may have symptoms and examination findings that may be similar to those that occur with optic nerve disease and cortically based conditions. These indicators may manifest as visual acuity loss, visual field defects, and a paucity of findings on ophthalmoscopic examination. Certain retinal disorders may also provide clues to the existence of an underlying neurologic illness or systemic disease. This chapter examines the relevant retinal anatomy, the distinction between maculopathy and optic neuropathies, maculopathies that may mimic optic neuropathy, retinal vascular occlusions, the photoreceptor disorders important in neuro-ophthalmic differential diagnosis (acute outer retinopathies, cancer-associated retinopathies), toxic and hereditary retinopathies of neuro-ophthalmic interest, and the retinal manifestations of neurologic and systemic diseases.
Autoimmune paraneoplastic syndromes associated to lung cancer: A systematic review of the literature: Part 3: Neurological paraneoplastic syndromes, involving the central nervous system
2017, Lung Cancer
Citation Excerpt :
The symptoms associated with CAR are caused by retinal damage and reflect both cone (photosensitivity following light exposure, reduced visual acuity, photopsias, glare, impaired color perception, central scotomas) and rod (nyctalopia, impaired dark adaptation, midperipheral scotomas and peripheral visual field loss) photoreceptor dysfunctions. In our systematic review, we could identify 68 cases secondary to lung cancer reported from 1990, published in either case reports [142–172] or case series [173–181], including 47 males (69%) with a median age of 68 years (range 44–89 years) and 21 females (31%) with a median age of 65 years (range 60–75 years). SCLC was the most frequent lung cancer (n = 50, 73.5%), followed by adenocarcinoma (n = 9, 13.2%), squamous cell carcinoma (n = 2), large cell neuroendocrine carcinoma (n = 2), uncharacterized NSCLC (n = 2) and poorly differentiated lung carcinoma (n = 1).
The development of new immune treatment in oncology and particularly for lung cancer may induce new complications, particularly activation or reactivation of auto-immune diseases. In this context, a systematic review on the auto-immune paraneoplastic syndromes that can complicate lung cancer appears useful. This article is the third of a series of five and deals mainly with neurological paraneoplastic syndromes involving the central nervous system.
Paraneoplastic retinopathies: an update on pathogenesis, diagnosis and management
2024, Annals of Eye Science
Ocular manifestations of common pulmonary diseases: a narrative review
2024, Monaldi Archives for Chest Disease

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^☆: Supported by grants from the Japanese Ministry of Health and Welfare, Grants-in-Aid for Scientific Research (B-15390523, B-11470361, B-12557145) from the Japanese Ministry of Education, Sports and Culture, and by the Karouji Memorial Foundation for Medical Research.

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Brief reportClinical and immunologic aspects of cancer-associated retinopathy☆

Abstract

Purpose

Design

Methods

Results

Conclusion

Pathological roles of recoverin in cancer-associated retinopathy

Adv Exp Med Biol

A clinical triad to diagnose paraneoplastic retinopathy

Ann Neurol

Brief report
Clinical and immunologic aspects of cancer-associated retinopathy☆