Intravitreal triamcinolone for cancer-associated retinopathy refractory to systemic therapy

Abstract

PurposeThe purpose of this study is to report the use of intravitreal triamcinolone for treatment of cancer-associated retinopathy (CAR) refractory to systemic therapy.MethodsThis was a retrospective chart review study.ResultsA 67-year-old man presented with cancer-associated retinopathy with antibodies against a 46-kDa retinal protein, alpha enolase. There was disease progression despite therapy with mycophenolate and intravenous immunoglobulin. Serial intravitreal injections of triamcinolone resulted in restoration of photoreceptor anatomy on optical coherence tomography and visual improvement. The patient’s vision was preserved at 20/40 OD and 20/32 OS until his death from lung cancer 31 months after CAR diagnosis.ConclusionsIntravitreal triamcinolone may be beneficial for maintenance of vision in patients with CAR.

Cystoid Macular Edema from Cancer-Associated Retinopathy

“…This includes ERGs and possibly serum testing. 11 VA improved from 20/ 125 OD to 20/40 OD, and from 20/60 OS to 20/32 OS. 4,5,10,13,16 Treatment Treatment effectiveness has been variable, and no standard treatment exists.…”

“…Those without cancer should consider undergoing an evaluation for cancer. 11 Another case report demonstrating a patient diagnosed with mild CME from CAR in neuroendocrine carcinoma was not treated. In theory, modulating the body's immunity should improve visual outcomes.…”

Paraneoplastic and non-paraneoplastic retinopathy and optic neuropathy: Evaluation and management

“…101 A subtle vitritis may be present, which may coincide with an anterior uveitis, and there may also be retinal vasculitis with or without cystoid macular edema (CME). 17,48,109,140,206,208,212,230,272 Rare presentations of CAR with associated choroidal neovascularization 229 and in combination with BDUMP 246 have also been described.…”

“…Isolated cases have documented perivascular leakage and CME on FA. 17,109,140,171,208,230,272 Optical coherence tomography (OCT) typically reveals severe macular atrophy, often associated with thinning of the photoreceptor layer, 166,215 loss of the inner segment/outer segment (IS/OS) junction, 109 and loss of the inner highly reflective layer. 185, 255 Lima et al 157 advocated the additional use of fundus autofluorescence together with high-definition spectral domain OCT to aid in the diagnosis of this entity and monitoring for progression.…”

“…Huynh et al 109 reported a CAR patient presenting with diffuse retinal vasculitis and CME on FA refractory to various systemic interventions, including intravenous methylprednisolone, oral prednisone, mycophenolate mofetil, and IVIg, s u r v e y o f o p h t h a l m o l o g y 5 8 ( 2 0 1 3 ) 4 3 0 e4 5 8 who then received five bilateral intravitreal corticosteroid injections over 2.5 years, resulting in stable visual function until the time of death. They suggested a causal relationship between the injections and resulting visual improvement.…”