Case 5

Patient Presentation: A 65-year-old male was referred for a 2-month history of acute, painless, vision loss OS. He denied any headaches, flashes or floaters. His past ocular history was significant for reduced visual acuity OD secondary to a myopic CNVM three years ago. His past medical history was significant for type II diabetes mellitus, hypertension and dyslipidemia; family history was non-contributory. His medications included metformin, perindopril and rosuvastatin. He had a 12-year smoking history. On examination, BCVA was 20/200 OD and 20/70 OS. There was no RAPD. IOP was normal. Dilated fundus exam was notable for 0.5+ vitreous cells OU.

Optos fundus photography and fundus autofluorescence were performed and shown below.

Question: Describe the images

IVFA was subsequently performed demonstrating posterior pole arteriolar staining (red arrow) as shown in the left eye below. The rest of the IVFA was otherwise unremarkable.

An OCT of the macula of the right and left eye was performed and shown below:

Question: Describe the findings on the OCT

Question: Based on the clinical presentation and imaging findings, which of the following diagnoses is highest on your differential to account for the patient’s decrease in BCVA OU?

Question: On further history, the patient endorses weight loss over the past 6 months.  Review of systems is otherwise negative.  Based on your suspicion, which of the following is the most reasonable next step?

Question: Which of the following could be appropriate management options for this patient?

Learning Objectives:

1. Identify OCT features of cancer associated retinopathy

2. Recognize the role of other imaging modalities in conjunction with OCT in diagnosing cancer associated retinopathy

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