Ophthalmology, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA.
Vitreoretinal Surgery, Retina Associates, Little Rock, Arkansas, USA.
BMJ Case Rep. 2024 Apr 25;17(4):e257911. doi: 10.1136/bcr-2023-257911.
We report the case of a woman in her 50s who presented headaches, blurred vision, diplopia and loss of peripheral vision. She was treated for normal tension glaucoma based on optic nerve cupping prior to the development of diplopia. Records demonstrated visual field constriction over 4 months despite well-controlled intraocular pressures. Examination revealed decreased visual acuity and visual field constriction. The multifocal electroretinogram was abnormal. After a thorough review of her medical and family history, a concern for cancer-associated retinopathy developed. Blood samples were positive for antiretinal antibodies against 23 kDA and 46 kDA proteins. Cancer screening was recommended as the aetiology for retinopathy was unknown and revealed a left breast lump. Following lumpectomy with adjuvant chemoradiation, her visual acuity normalised and visual field defects completely resolved. This case serves to provide an example that distant systemic symptoms may be a manifestation of the underlying malignancy and the importance of clinical suspicion with prompt evaluation.
我们报告了一例 50 多岁女性患者，她出现头痛、视力模糊、复视和视野缺损。在出现复视之前，根据视神经杯状凹陷，她被诊断为正常眼压性青光眼，并接受了治疗。尽管眼压得到了良好控制，但记录显示视野在 4 个月内逐渐缩小。检查发现视力和视野均有下降。多焦视网膜电图异常。在详细回顾她的病史和家族史后，我们对癌症相关性视网膜病变表示担忧。血液样本对 23kDa 和 46kDa 蛋白的抗视网膜抗体呈阳性。由于视网膜病变的病因不明，建议进行癌症筛查，并发现左侧乳房有肿块。接受乳房肿块切除术和辅助放化疗后，她的视力恢复正常，视野缺损完全消失。这个病例表明，远处的全身症状可能是潜在恶性肿瘤的表现，需要临床怀疑和及时评估。
