Related Experiment Video
Updated: Jan 27, 2026
Implantation and Evaluation of Melanoma in the Murine Choroid via Optical Coherence Tomography
Published on: December 2, 2022
Outcomes Associated With Sustained-Release Intraocular Fluocinolone Implants in a Case of Melanoma-Associated
Eleni Karatsai1, Anthony G Robson2,3, Simon R J Taylor1,4
1Royal Surrey County Hospital, Guildford, United Kingdom.
Importance:
Melanoma-associated retinopathy (MAR) is a paraneoplastic syndrome in which antiretinal antibodies crossreact with retinal ON-bipolar cells, resulting in night blindness and progressive visual field loss. Current therapeutic options include cytoreductive surgery in combination with immunoglobulin, corticosteroids, or plasmapheresis, but their effectiveness is limited and may be contraindicated, given the possible protective role of circulating autoantibodies against metastatic spread. We report 3-year follow-up of the first case (to our knowledge) of MAR treated with intravitreal long-acting steroid implants.
Objective:
To report on a patient with MAR who was treated with intravitreal fluocinolone acetonide implants in the absence of systemic immunosuppression.
Design, Setting, And Participants:
This is a 3-year follow-up of a 73-year-old woman with a history of surgical excision of a malignant melanoma of the left pinna who presented with visual symptoms of shimmering and nyctalopia. Fundus examination, fundus autofluorescence, and optical coherence tomography were normal, with no evidence of cystoid macular edema. Automated perimetry showed a reduction in visual field and full-field electroretinography (ERG) demonstrated findings consistent with generalized ON-bipolar cell dysfunction, typical of MAR. The patient was treated with bilateral fluocinolone acetonide intravitreal implants.
Main Outcomes And Measures:
Visual acuity, visual field, and electroretinography testing for 3 years after treatment.
Results:
Visual fields improved in this 73-year-old patient from 20/30 (Snellen measured as 6/9) OD and 20/16 (6/5) OS at baseline to 20/20 OU within 1 week of treatment. Detailed electroretinography monitoring indicated characteristic abnormalities that partly resolved after treatment, consistent with improved inner retinal ON-bipolar cell function. Bilateral cataracts developed approximately 2 years after injection; cataract surgery was performed uneventfully. At 3 years posttreatment, the patient remained visually stable and in systemic disease remission, with best-corrected visual acuity remaining at 20/20 OU.
Conclusions And Relevance:
We report what is, to our knowledge, the first case of MAR treated with intravitreal slow-release corticosteroid implants, which shows improvements in visual symptoms, visual fields, and retinal function. Sustained-release intraocular steroid implants may offer an effective and safe alternative to systemic immunosuppression in MAR, although results from 1 case should be generalized with abundant caution.
Insights
This study reports a 3-year follow-up of a patient with Melanoma-associated retinopathy (MAR) treated with intravitreal steroid implants. The treatment led to improved vision and retinal function, suggesting a potential alternative to systemic immunosuppression for MAR.
Area of Science:
- Ophthalmology
- Oncology
- Immunology
Background:
- Melanoma-associated retinopathy (MAR) is a paraneoplastic syndrome causing visual impairment due to antiretinal antibodies targeting ON-bipolar cells.
- Current treatments for MAR have limited efficacy and potential contraindications due to the possible protective role of autoantibodies against cancer metastasis.
Observation:
- A 73-year-old woman with a history of malignant melanoma presented with symptoms of shimmering and nyctalopia.
- Initial examinations showed normal ocular structures but visual field reduction and electroretinography (ERG) findings consistent with ON-bipolar cell dysfunction, indicative of MAR.
Findings:
- Treatment with bilateral fluocinolone acetonide intravitreal implants resulted in rapid visual field improvement and partial resolution of ERG abnormalities within weeks.
- The patient maintained stable vision (20/20 OU) and systemic disease remission over 3 years, despite developing cataracts requiring surgery.
- Intravitreal implants demonstrated sustained efficacy in improving visual function and retinal electrophysiology in this MAR case.
Implications:
- Intravitreal slow-release corticosteroid implants may represent a safe and effective alternative to systemic immunosuppression for managing Melanoma-associated retinopathy.
- This approach warrants further investigation as a potential therapeutic strategy for patients with MAR, balancing visual preservation with oncologic considerations.
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