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Hiroki Imai, Kouichi Ohta, Takanobu Kikuchi, Yusuke Komurasaki, Daigo Miyazaki, Shuichi Ikeda; Cancer-associated Retinopathy in Patient with Seminoma. Invest. Ophthalmol. Vis. Sci. 2011;52(14):4310.
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We report our findings on a patient with cancer-associated retinopathy (CAR) who was diagnosed with seminoma.
A retrospective case report with clinical evaluation and diagnostic testing.
A 43-year-old male complained of blurred vision of his left eye in November 2009. He was diagnosed with uveitis and treated with topical corticosteroids. At this time, his left testis was swollen, and surgically extracted. Histopathological examination of tissue showed a Stage 1 seminoma. Thereafter, the blurred vision did not improve and the visual field defects worsened. CAR caused by seminoma was suspected. He began treatment with oral and local steroid. He was referred to the Shinshu University Hospital on April 28, 2010 for consultation. His visual acuity (VA) was 1.5 OD and 1.2 OS. Although his pupillary reflexes and slit-lamp examinations were normal, ophthalmoscopy showed attenuated retinal arteries, mild optic disk pallor, and a visibility of the choroidal vessels. Optical coherence tomography showed a thinning of the outer nuclear layer. Both visual fields showed a ring scotoma. The amplitudes of electroretinogram were moderately reduced. Antibodies against recoverin, Hu, and Ma-2 antigens were not detected. The western blots of the serum detected two bands at 41 and 64 kDa. The 41 kDa band, but not the 64 kDa band, was an anti-retina-specific antibody. Immunoreactivity with his antiserum showed on the photoreceptor layer in murine retina. From these findings, we diagnosed with CAR and began intravenous immunoglobulin (IVIg) for 6 days. After this therapy, visual field defects and VA remained stable although the steroid dosage was gradually tapered.
It was a first case of CAR due to seminoma, and was detected a 41 kDa anti-retina-specific antibody which immunoreactivity identified in the photoreceptor layer. Steroid treatment and IVIg are effective to maintain visual function.
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