Loss of Retinal Pigment Epithelium Associated with Bilateral Diffuse Uveal Melanocytic Proliferation

A 69-year-old woman was evaluated for poor visual acuity in both eyes despite recent cataract extractions. She had bilateral distinct melanocytic lesions in the posterior uvea and retinal pigment epithelial loss over these lesions and over normal-appearing choroid. Fluorescein angiography showed patchy areas of mottled hypofluorescence and hyperfluorescence. Optical coherence tomography demonstrated focal deposition of material over atrophic retinal pigment epithelium. Electroretinography showed decreased a- and b-wave amplitudes under scotopic and photopic conditions. The diagnosis of bilateral diffuse uveal melanocytic proliferation immediately led to the discovery of bronchogenic carcinoma and the patient died 10 days later. This case study suggests that different paraneoplastic stimuli may be operational over the retinal pigment epithelium and uveal melanocytes and that certain features of bilateral diffuse uveal melanocytic proliferation and cancer-associated retinopathy may coexist.