However, at this stage of the work-up, the possibility of a unilateral retinopathy of non-vascular etiology could not yet be entirely excluded

However, at this stage of the work-up, the possibility of a unilateral retinopathy of non-vascular etiology could not yet be entirely excluded. it is rarely observed in association with prostate cancer. A combination of visual function testing methods permitted the recognition, in this highly unusual case, of the concurrent presence of unilateral ERG changes most likely attributable to CRAO complications in OS, in all likelihood unrelated to CAON, and not to be confused with unilateral CAR. Auto-Ab testing in combination with visual function tests helps achieve a better understanding of the pathophysiology of vision loss in paraneoplastic visual syndromes. of the disc area in OD and OS, respectively, showing the juxtapapillary atrophy and pigmentary changes around the disc OU. Compared to OD, vascular attenuation, epipapillary perivascular sheathings (at the cilio-retinal artery in the indicate the timings normal range of the P100. c The ERG assessments are completely normal in OD, while OS shows delayed timing and reduced amplitudes; the is nearly absent in the mixed rod-cone response, and cone and flicker responses are markedly reduced [shown magnified at lower scale in the to illustrate that they remained RPR107393 free base nonetheless recordable]. are for amplitudes in microvolts (V), and are for response timing in milliseconds (ms). Rod: rod-driven dark-adapted response; Mix: mixed rod/cone-driven dark-adapted response; Cone: cone-driven transient light-adapted response; Flick: cone-driven, light-adapted response to flicker stimuli Pattern-reversal VEPs (Fig. 2b) revealed progressively smaller amplitudes and progressively more delayed timing RPR107393 free base in both eyes as a function of decreasing stimulus size. Consistent with the Goldmann visual field findings, VEPs were more severely compromised OD. These findings further confirmed the suspicion of a bilateral optic neuropathy, but did not entirely allow us to rule out a retinopathy affecting primarily the posterior pole. After 30 min of dark-adaptation, flash ERGs were performed (Fig. 2c). Somewhat surprisingly, findings were completely normal OD, but were all markedly diminished OS. Particularly, the mixed rod-cone dark-adapted ERG showed a reduction of the a-wave by about 50 % 50 % compared to OD and a virtually absent b-wave (electronegative response). This obtaining was suggestive of possible sequelae of central retinal artery occlusion (CRAO) OS, or of an otherwise unilateral retinopathy OS. An IVFA was therefore performed. The early phases of the angiogram showed clearly the presence of a cilio-retinal artery OS that filled before the retinal circulation (Fig. 1c). Later phases showed bilateral staining around the temporal aspect of the disc (Fig. 1dCg), corresponding to areas of pigmentary scarring, suggestive of a previous inflammatory event affecting the optic nerves. There was a large area of retinal pigment epithelial windows defects and staining along the inferior temporal arcade OS, suggestive of a previous retinal event (Fig. 1d). These retinal changes were not apparent in OD. Macular SD-OCT findings appeared, at this stage, within normal limits, and so was the RNFL of the optic disc (not shown). At this stage of the work-up of this patient, it was concluded that the most probable explanation for the progressive visual loss was a bilateral optic neuropathy. The ERG findings were interpreted essentially as incidental, most likely subsequent to sequalae of CRAO that had probably occurred shortly after the cataract surgery OS but had gone undetected (and with far less serious visual loss sequelae than usual) because of the serendipitous presence of a cilio-retinal artery that mitigated significantly the resulting degree of visual loss OS. The presence of the cilio-retinal artery explained well also the horizontal band of preserved central sensitivity to the I4e in OS on Goldmann visual field testing (Fig. 2a). However, at this stage of the work-up, the possibility of a unilateral retinopathy of non-vascular etiology could not yet be entirely excluded. In concern of the history of prostate cancer, the suspicion RPR107393 free base of a RPR107393 free base bilateral CAON was raised, with a possible unilateral CAR, and diagnostic testing for anti-retinal and anti-optic nerve auto-Abs was ordered, along with retinal IHC. Retinal IHC showed no staining of the human donor retinal tissue. Western blots were unfavorable for anti-retinal auto-Abs, including RPR107393 free base no reactivity against common retinal proteins involved in retinal autoimmunity such as recoverin and Rabbit Polyclonal to PE2R4 against optic nerve antigens [7], which suggests that CAON may be the most common type of paraneoplatic visual loss associated with prostate cancer. The differential diagnosis of this case was particularly challenging since this was not a simple case of CAON, but.