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Journal of Neuro-Ophthalmology:
doi: 10.1097/WNO.0b013e3181fd9435
Letters to the Editor

Long-Term Survivor of Paraneoplastic Optic Neuropathy

Pau, Derrick MD; Yalamanchili, Sushma MD; Lee, Andrew G MD

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Department of Ophthalmology (DP, SY), The Methodist Hospital, Houston, Texas; Department of Ophthalmology (AGL), The Methodist Hospital, Houston, Texas; Department of Ophthalmology (AGL), The Methodist Hospital, Houston, Texas; Departments of Ophthalmology, Neurology, and Neurosurgery (AGL), Weill Cornell Medical College, New York, New York; Department of Ophthalmology (AGL), University of Iowa Hospitals and Clinics, Iowa City, Iowa; and Department of Ophthalmology (AGL), UTMB-Galveston, Galveston, Texas

Small cell lung cancer carries a very poor long-term prognosis. In a survey performed at the Mayo Clinic from 1997 to 2003, the 5-year survival rate was only 9% (1). In addition, to our knowledge, the longest published survival duration for paraneoplastic optic neuropathy secondary to small cell lung cancer has been 8 years (2). We wish to provide an update on a patient previously reported by one of us (A.G.L.) in this Journal in 1998 (3) who returned 14 years later without evidence of tumor recurrence and believed to be in clinical remission. The earlier detection of the tumor from her neuro-ophthalmologic examination followed by timely systemic treatment may have contributed to her favorable outcome. To the best of our knowledge, she is the longest survivor of paraneoplastic optic neuropathy secondary to small cell lung cancer. At the time of her diagnosis, she underwent surgery, chemotherapy, and radiation therapy and was believed to be in remission at the last follow-up.

The patient, a 73-year-old white woman, was last seen in the neuro-ophthalmology clinic on July 20, 2010. She was complaining of blurred vision in the left eye that had worsened since sustaining a fall on March 1, 2010. She was seen by her neurologist who obtained a brain MRI that showed no focal lesions.

Best-corrected visual acuity was 20/30 in the right eye and 20/40 in the left eye without a relative afferent pupillary defect. Ishihara color plate testing was intact in both eyes, and she was orthotropic on cover-uncover testing. Confrontation visual fields were full. Ocular motility was full with normal pursuit and saccades. There was no nystagmus or cerebellar eye signs. Slit-lamp examination revealed no uveitis and cataracts that were consistent with the patient's level of vision. Ophthalmoscopy was normal and automated visual fields revealed nonspecific peripheral depression bilaterally.

Over the years, the patient has been seen regularly by her oncologist and determined to be stable. Chest CT performed in March 2010 showed no evidence of recurrent or metastatic disease. The patient returned to The Methodist Hospital after 10 years of follow-up to specifically report on her progress and survival from small cell carcinoma of the lung.

Derrick Pau, MD

Sushma Yalamanchili, MD

Department of Ophthalmology, The Methodist Hospital, Houston, Texas

Andrew G. Lee, MD

Department of Ophthalmology, The Methodist Hospital, Houston, Texas

Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medical College, New York, New York

Department of Ophthalmology, University of Iowa Hospitals and Clinics, Iowa City, Iowa

Department of Ophthalmology, UTMB-Galveston, Galveston, Texas

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REFERENCES

1. Yang P, Allen MS, Aubry MC, Wampfler JA, Marks RS, Edell ES, Thibodeau S, Adjei AA, Jett J, Deschamps C. Clinical features of 5,628 primary lung cancer patients: experience at Mayo Clinic from 1997 to 2003. Chest. 2005;128:452-462.

2. Cross SA, Salomao DR, Parisi JE, Kryzer TJ, Bradley EA, Mines JA, Lam BL, Lennon VA. Paraneoplastic autoimmune optic neuritis with retinitis defined by CRMP-5-IgG. Ann Neurol. 2003;54:38-50.

3. Luiz JE, Lee AG, Keltner JL, Thirkill CE, Lai EC. Paraneoplastic optic neuropathy and autoantibody production in small-cell carcinoma of the lung. J Neuroophthalmol. 1998;18:178-181.

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This article has been cited 1 time(s).

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10.1016/j.survophthal.2012.09.001
CrossRef
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