Clinical characteristics of paraneoplastic retinopathy and optic neuropathy

Objective To analyze the clinical characteristics of paraneoplastic retinopathy and optic neuropathy (PRON). Methods Case series study.Eight patients were enrolled from October 2006 to March 2012 visited in ophthalmology department,the People Liberation Army General Hospital.The patients were underwent a series of examinations,including fundus photography,visual electrophysiology,fundus fluorescein angiography,optic coherent tomography,fundus autofluorescent imaging,perimetry,ultrasonography,magnetic resonance imaging,spinal tap and cerebrospinal fluid test,paraneoplastic syndrome (PNS) antibody test.The patients were followed up in outpatient department and (or) by phone.The clinical manifestation,entity types,and treatment were analyzed. Results Of the eight patients,there were cancer associated retinopathy (CAR) 3 cases,bilateral diffuse uveal melanocytic proliferation (BDUMP) 2 cases and paraneoplastic optic neuropathy (PON) 3 cases.Five patients were detected the PNS antibodies and revealed three patients with positive results.As for the primary malignancy,four of the eight patients were lung carcinoma,others included invasive thymoma,kidney cancer,acute lymphocytic leukemia and cervical cancer,each for one case.All the patients complained vision blurring or progressive visual decrease.Other complaints included dark shadow in two patients,shimmering,dazzling,double vision and eye pain,each in one patient.One patient complained progressive decreased vision in both eyes prior to the diagnosis of lung cancer.Of the 16 eyes of the eight patients,there were six patients with no light perception vision,five from light perception to 0.05,and other five with no less than 0.4 vision,in the end of the follow up.Five patients were treated with steroid with unsatisfactory efficacy. Conclusions Each entity of PRON has its own clinical characteristics.PRON especially BDUMP may be a pre-metastatic disease. (Chin J Ophthalmol,2013,49:507-513) Key words: Paraneoplastic syndromes,ocular; Retinal diseases; Optic nerve diseases