Optical coherence tomography findings in paraneoplastic pseudovitelliform lesions in melanoma-associated retinopathy

Abstract

Purpose: To report an unusual case of paraneoplastic pseudovitelliform lesions associated with melanoma-associated retinopathy (MAR).

Design: Observational case report.

Methods: Retrospective review of the ophthalmic examination, fundus photography, fluorescein angiography, electroretinogram (ERG), and optical coherence tomography (OCT) of a patient with MAR.

Results: A 65-year-old Caucasian man with a two-year history of metastatic melanoma was referred for evaluation of a six-month history of nyctalopia. Funduscopic examination in both eyes revealed multiple, creamy, yellow, pseudovitelliform lesions in the posterior pole, varying in size from 100-500 mum, at the level of the outer retinal/retinal pigment epithelium (RPE) junction, coalescing along the inferior portion, with overlying macular neurosensory detachments. OCT showed bilateral macular neurosensory detachments with multiple small areas of high reflectivity at the level of the outer retinal/RPE junction. ERG demonstrated a selective loss of the b-wave and a normal a-wave under dark adapted, scotopic conditions.

Conclusion: Clinicians should be aware of this atypical presentation of MAR that may include pseudovitelliform retinal findings.

Keywords: cancer-associated retinopathy; melanoma-associated retinopathy; optical coherence tomography; paraneoplastic pseudovitelliform retinopathy; paraneoplastic syndrome.

Figure 1

Fundus photography and fluorescein angiography. A: Fundus photography of both eyes revealed symmetric, multiple creamy yellow vitelliform lesions in the posterior pole arranged in a honeycomb pattern, varying in size from 100–500 μm, at the level of the RPE/outer retina, coalescing along the inferior portion, with overlying macular neurosensory detachments. Few lesions were noted outside the posterior pole. B–D: Fluorescein angiography of the right eye at thirty-eight seconds, sixty-four seconds, and one hundred and eighty-seven seconds exhibiting small areas of blocked fluorescence secondary to the vitelliform retinal lesions with early leakage into the overlying neurosensory detachment. There is widespread blockage seen inferiorly along the vessels where the lesions have coalesced.

Figure 2

Optical coherence tomography. A: Optical coherence tomography of the macula through the foveal center shows areas of both neurosensory fluid and RPE detachment. There are multiple areas of high reflectivity along portions of the outer retina and retinal pigment epithelium. Some areas of cystic retinal change area also present. B: Optical coherence tomography of the macula through the lateral edge of the vitelliform lesions shows both neurosensory and RPE detachment with multiple areas of high reflectivity along portions of the outer retina and retinal pigment epithelium. Note the corrugated appearance of the outer retina/RPE secondary to the vitelliform lesions.