Angular Sign of Henle Fiber Layer Hyperreflectivity (ASHH) in Cancer-Associated Retinopathy.

Area of Science:

• Ophthalmology
• Oncology
• Medical Imaging

Background:

• Cancer-associated retinopathy (CAR) is an autoimmune disorder targeting photoreceptors.
• Early detection and understanding of CAR progression are crucial for patient outcomes.
• Multimodal imaging plays a key role in diagnosing and monitoring retinal diseases.

Purpose of the Study:

• To describe longitudinal multimodal imaging findings in two CAR patients.
• To investigate the significance of the angular sign of Henle fiber layer hyperreflectivity (ASHH) on spectral-domain optical coherence tomography (SD-OCT).
• To correlate imaging findings with clinical presentation and prognosis.

Main Methods:

• Retrospective case series.
• Analysis of spectral-domain optical coherence tomography (SD-OCT) findings.
• Correlation of imaging features with visual acuity and visual field data.

Main Results:

• Two patients with systemic malignancy (endometrial and prostate cancer) presented with bilateral ASHH lesions.
• ASHH lesions preceded significant ellipsoid zone (EZ) loss and outer retinal atrophy.
• Both patients experienced rapid vision loss and poor functional outcomes despite treatment.

Conclusions:

• ASHH lesions on OCT may serve as an early biomarker for photoreceptor toxicity in paraneoplastic retinopathy.
• The presence of ASHH indicates a rapidly progressive disease course.
• ASHH is associated with a poor prognostic factor in cancer-associated retinopathy.