Topic outline

  • Grand Rounds

    A patient with a history of advanced ovarian cancer presented with flashes, glare and peripheral visual field loss of 10 months duration. Best-corrected visual acuity was 20/30 in the right eye and 20/40 in the left eye with normal intraocular pressures in both eyes. Slit lamp exam showed no cells or flare in the anterior chamber and vitreous, but was significant for subtle diffuse pigmentary changes and vascular attenuation in both eyes. Optical coherence tomography showed ellipsoid irregularity in both eyes and Humphrey visual field testing showed severe diffuse visual field loss in both eyes, which was progressive from testing 6 months prior. Electroretinogram showed decreased cone responses in both eyes, leading to the diagnosis of paraneoplastic, or cancer-associated, retinopathy. The patient was treated with intravitreal triamcinolone injections in both eyes. Systemic immunomodulatory therapy was avoided as the patient was undergoing treatment for her ovarian cancer, although intravenous immunoglobulin was suggested to her oncologist. The patients’ subjective complaints, visual field testing, and multimodal imaging demonstrated a reliable response to the steroid injections and treated was continued and maintained for the duration of the follow-up. At the last visit 1 year after presentation, best-corrected visual acuity was 20/25 in the right eye and 20/20 in the left eye and visual fields were stable.

    Presentation Date: 05/05/2022
    Issue Date: 06/17/2022