29 KB197 KB28 KB192920262005Brecelj, JelkaHawlina, MarkoHolder, GrahamŠket-Kontestabile, Alenkaštevilka:10letnik:74str. 643-647ISSN:1318-0347COBISSID:20411353URN:URN:NBN:SI:doc-QSRROXIIslSlovensko zdravniško društvoZdravniški vestnikAdultdiagnostikaElectroretinographyElektroretinografijaFundus OculimalignomiMelanomMelanomaMiddle AgemrežnicaMrežnica, bolezniočesne bolezniOčesno ozadjeOdraslioftalmologijaParaneoplastic SyndromesParaneoplastični sindromiRetinal DiseasesRetinitisretinopatijaSrednja letaParaneoplastične retinopatije| Paraneoplastic retinopathies|Background. Two types of retinopathy are known to be associated with patients with malignancies: cancer associated retinopathy-CAR and cutaneus melanoma associated retinopathy-MAR. Autoantibodies against recoverin or against alfa-enolase have been described in CAR, and autoatibodies against ON-bipolar cells are formed in MAR. An outline of the pathogenetic mechanisms and an example of each cases disorder presented. Case reports. In both patients, the following were performed: complete clinical examination, visual acuity, visualfields, fluorescein angiography and electroretinography. The first patient was a 78 year-old man with epidermoid carcinoma of the the lung and metastases of liver and kidney suffered rapidly progressive bilateral visual loss. He suffered complete loss of visual (amaurosis with Antons syndrome). Retinal examination showed severe arterial narrowing with lipid plaques and age-related pigmentary changes. The ERG was nondetectable, and the diagnosis was CAR. The second patient was a 62 years old man who presented with acute onset of bilateral night blindness, photopsia and shimmering four years after excision of a cutaneus malignant melanoma. Visual acuity was 0.5 in the right eye and 0.8 in the left eye. The visual fields showed constriction to 15 degrees in both eyes on Goldmann perimetry. The retinal examination was normal. ERG maximal response was electronegative, with normal a-wave amplitudeand reduced b-wave. ON-OFF ERG showed loss of ON-response B-wave and normal OFF-response d-wave, typical for MAR. Conclusions. CAR and MAR are rareparaneoplastic sindromes, that are characterised by rapid onset of acquired bilateral visual loss and night blindness. (Abstract truncated at 2000 characters)Izhodišča. Predstavljamo dva tipa paraneoplastičnih retinopatij v povezavi z malignimi boleznimi: retinopatija v povezavi z malignomom, navadno karcinomom-CAR (cancer-associated retinopathy) in retinopatija v povezavi s kožnim melanomom-MAR (cutaneous melanoma associated retinopathy). Pri CAR najpogosteje pride do tvorbe protiteles proti recoverinu oz. alfa-enolazi, priMAR pa se tvorijo protitelesa proti transducinu v ON-biopolarnih celicah. Prikaz primerov. Opisana je klinična slika in rezultati preiskav dveh bolnikov, ki sta bila zaradi hitre izgube vida sprejeta na očesno kliniko. V prvem primeru je šlo za 78-letnega bolnika z epidermoidnim karcinomom pljuč inmetastazami v jetrih in ledvici, ki se mu je vid hitro slabšal do popolne slepote na obeh očeh. Prisotna je bila amavroza z Antonovim sindromom, pregledočesnega ozadja je pokazal ozke arterije, mestoma z ateromskimi plaki, v makuli grobo pregrupacijo pigmenta. Skotopična in fotopična elektroretinografija (SFERG) je bila neizzivna. Drugi bolnik je bil 62-letni gospod, ki je leto dni po operativni odstranitvi kožnega melanoma opazil poslabšanje nočnega vida in fotopsije, pa tudi poslabšanje centralnega vida. Vidna ostrina na desnem očesu je bila 0,5 in na levem očesu 0,8. Vidno polje je bilo koncentrično zoženo znotraj 15 stopinj na obeh očeh. Na očesnem ozadjuni bilo večjih nepravilnosti. SFERG je pokazala maksimalni odgovor negativne oblike, z normalnim a valom in znižanim b valom. ON-OFF ERG je pokazal izgubo ON odziva-b vala in normalen OFF odziv-d vala, kar je značilno za MAR. Zaključki. CAR in MAR sta redka paraneoplastična sindroma, za katera je značilna hitra obojestranska izguba vida in nočna slepota brez večjih sprememb na očesnem ozadju. Značilne elektroretinografske spremembe lahko opozorijo na možno maligno obolenje še pred razvojem popolne slepote, zato je pomembno, da se tega zapleta pri onkoloških bolnikih zavedamoTEXTznanstveno časopisjejournalsSlovenian National E-content AggregatorNational and University Library of SloveniaSlovensko zdravniško društvo