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Intravitreal dexamethasone implant use as first-line therapy for cancer-associated retinopathy
  1. Joel Mudri1,
  2. Ravinder Singh Phagura1,
  3. Wei-Sen Lam2 and
  4. Xia Ni Wu1
  1. 1Ophthalmology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
  2. 2Medical Oncology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
  1. Correspondence to Dr Joel Mudri; joel.mudri{at}health.wa.gov.au

Abstract

We present a 65-year-old female smoker who presented with acute bilateral blurred vision. Investigations led to an endobronchial ultrasound-guided fine-needle aspiration resulting in an early diagnosis of limited stage small cell lung cancer. Positive recoverin antibodies supported the diagnosis of cancer-associated retinopathy (CAR). CAR was the first manifestation of systemic malignancy in our patient and early diagnosis enabled curative intent systemic treatment with chemotherapy and radiotherapy. Ocular-specific treatment is required in CAR, although no standardised treatment exists. Current treatment options include steroids and immunosuppressive agents. Our patient was administered bilateral intravitreal dexamethasone implants, resulting in significant visual field and electroretinogram improvement at 8 weeks post-intervention. To our knowledge, this represents the first reported successful use of intravitreal dexamethasone implants as first-line therapy, in conjunction with chemoradiotherapy. Intravitreal dexamethasone implants therefore may provide an effective and safe treatment for CAR by reducing intraocular inflammation without systemic effects.

  • ophthalmology
  • retina
  • lung cancer (oncology)

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Footnotes

  • Contributors All authors have provided significant contribution to the case. JM/RSP were the first doctors reviewing the patient at presentation. They were responsible for initial drafting of the manuscript with revisions and literature review. XNW was the supervising ophthalmology consultant and was responsible for institution of the ophthalmological management plan. She was also responsible for final drafting of the manuscript. W-SL was the supervising oncology consultant that provided oncological care of the patient. He also provided consultation on the manuscript from an oncological perspective. All coauthors support the final manuscript, agree with its findings and accept responsibility for its content.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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