Clinical and Immunological Characterization of Paraneoplastic Retinopathy
Clinical and Immunological Characterization of Paraneoplastic Retinopathy
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DOI：
10.1167/iovs.13-11868
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发表时间：
2013-08-01
影响因子：
4.4
通讯作者：
Yoshimura, Nagahisa
中科院分区：
文献类型：
--
作者：
Makiyama, Yukiko;Kikuchi, Takanobu;Yoshimura, Nagahisa
目的.目的探讨副肿瘤性视网膜病变（PR）的临床和免疫学特征，以及光谱域光学相干断层扫描（SDOCT）结果与PR自身抗体靶点之间的关系。我们回顾性招募了8名患者，（年龄范围：57-85岁;所有患者进行全面的眼科检查，包括最佳矫正视力（BCVA）测量、裂隙灯检查、用Goldmann视野计进行的动态视野测试、视网膜电图（ERG）、眼底照相术、荧光素血管造影术、眼底自发荧光（FAF）、SDOCT，和血清样品测试（蛋白质印迹分析和免疫组织化学[IHC]）。3例患者有恶性肿瘤病史，4例患者新诊断为肿瘤（小细胞肺癌[SCLC]、胸腺瘤、胰腺神经内分泌肿瘤和结肠癌）。在1例有恶性肿瘤（膀胱癌和脂肪肉瘤）病史的患者中检测到另一例新发恶性肿瘤（SCLC）。这些患者的BCVA范围为手部运动至1.5。Goldmann视野检查显示岛状、环形、同心圆或中心暗点。所有患者的ERG均显示不可记录或振幅降低的结果。在5例患者中检测到荧光素渗漏。在6例患者中检测到FAF的高自体荧光和/或低自体荧光。血清样本测试确定所有患者的抗视网膜抗体。免疫组化显示血清中含有抗感光细胞抗体或抗视网膜色素上皮抗体的患者，在SDOCT上显示外层视网膜受损。在该病例系列中，PR与各种肿瘤和自身抗体相关。光谱域OCT可用于表征形态学变化，并且这些变化与自身抗体的靶点相关。
PURPOSE. To report the clinical and immunological characterization of paraneoplastic retinopathy (PR) and to investigate the association between spectral-domain optical coherence tomography (SDOCT) findings and the targets of autoantibodies in PR.METHODS. We retrospectively enrolled eight patients (age range, 57-85 years; four men and four women) suspected of having PR. All patients underwent comprehensive ophthalmic examinations, including best-corrected visual acuity (BCVA) measurement, slitlamp examinations, kinetic visual field testing with Goldmann perimetry, electroretinography (ERG), fundus photography, fluorescein angiography, fundus autofluorescence (FAF), SDOCT, and serum sample tests (Western blot analysis and immunohistochemistry [IHC]).RESULTS. Three patients had a history of malignant tumors, and four patients were newly diagnosed as having neoplastic tumors (small cell lung carcinoma [SCLC], thymoma, pancreatic neuroendocrine neoplasm, and colon cancer). Another de novo malignancy (SCLC) was detected in a patient with a history of malignancy (bladder cancer and liposarcoma). The BCVA in these patients ranged from hand motion to 1.5. Goldmann perimetry revealed island, ring-shaped, concentric, or central scotoma. All patients showed nonrecordable or reduced amplitude results on ERG. Fluorescein leakage was detected in five patients. Hyperautofluorescence and/or hypoautofluorescence on FAF was detected in six patients. The serum sample tests identified anti-retinal antibodies in all patients. Patients whose serum contained anti-photoreceptor or anti-retinal pigment epithelium antibody on IHC showed damage of the outer retina on SDOCT.CONCLUSIONS. In this case series, PR was associated with a variety of neoplasms and autoantibodies. Spectral-domain OCT can be used to characterize morphologic changes, and the changes were associated with the targets of autoantibodies.