SUCCESSFUL TREATMENT OF CANCER-ASSOCIATED RETINOPATHY WITH INTRAVITREAL DEXAMETHASONE IMPLANT FOLLOWED BY A 0.18-MG FLUOCINOLONE IMPLANT WITHOUT SYSTEMIC IMMUNOSUPPRESSION.

Purpose: The aim of the study was to report a case of clinically diagnosed cancer-associated retinopathy successfully treated with intravitreal corticosteroid implants without systemic immunosuppression.

Methods: This was a case report with multimodal imaging.

Results: An 80-year-old man without known systemic malignancy presented with debilitating shimmering, hemeralopia, and rapidly progressive bilateral vision loss following uncomplicated cataract surgery. Mild vitritis, extensive photoreceptor loss, mottling of retinal pigment epithelium, and mild vascular attenuation were found in both eyes. Full-field electroretinogram showed severe bilateral rod-cone dysfunction. Infectious etiologies and vitreoretinal lymphoma were ruled out. During cancer workup, intravitreal corticosteroid treatment was offered. Significant anatomical improvement with reconstitution of the ellipsoid zone, improved retinal pigment epithelium irregularities, and functional improvement were observed 3 weeks after bilateral intravitreal dexamethasone implants (Ozurdex). After 2 months, the patient received bilateral intravitreal 0.18-mg fluocinolone acetonide implants (YUTIQ). Later, a colonic adenocarcinoma was found (pathologic stage pT3 pN0). The patient recovered well from surgery, and no chemotherapy was needed. Nine months since bilateral intravitreal fluocinolone acetonide implants (11 months since bilateral intravitreal dexamethasone implants), best-corrected vision maintained at 20/25-2 in the right eye and 20/20 in the left eye without ongoing treatments. Bilateral reconstitution of ellipsoid zones and near resolution of retinal pigment epithelium irregularities remained stable. Repeat full-field electroretinogram demonstrated improved cone response in the left eye and stable diminished rod response in both eyes. The patient reported resolution of ocular symptoms.

Conclusion: The sustained improvements with intravitreal corticosteroid monotherapy suggest potential advantages using local therapy over systemic treatment. A long-term follow-up is warranted. Further research is needed to evaluate the efficacy of using the 0.18-mg fluocinolone implant (YUTIQ) to treat cancer-associated retinopathy.