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

Michael Javaheri¹, Rahul N Khurana¹, Rizwan A Bhatti¹, Jennifer I Lim²

¹Doheny Retina Institute, Doheny Eye Institute, Department of Ophthalmology, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA; ²Eye and Ear Infirmary, Department of Ophthalmology, University of Illinois, Chicago, IL, USA

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 µm, 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 refl ectivity 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 syndrome, paraneoplastic pseudovitelliform retinopathy