Long Term of Follow-Up of Melanoma-Associated Retinopathy: A Case Report

Case report.

Melanoma-associated retinopathy (MAR) is a rareparaneoplastic autoimmune disorder characterized by retinal dysfunction inpatients with cutaneous melanoma. While typically presenting with photopsias, nyctalopia, and peripheral vision loss, diagnosis remains challenging due tooften normal fundoscopic findings and variable autoantibody detection. Thisreport describes a unique case of recurrent MAR managed successfully withintravitreal dexamethasone over a decade-long follow-up.

A 48-year-old man with stage IV cutaneousmelanoma with BRAF V600E mutation achieved complete systemic remission with vemurafenib. During ophthalmological screening, he reported nyctalopia andphotopsias; clinical examination and optical coherence tomography wereunremarkable. Full-field electroretinography (ERG) revealed an electronegativewaveform (reduced b-wave), confirming MAR despite negative antiretinalantibodies. Sub-Tenon's triamcinolone and intravenous immunoglobulin failed toimprove symptoms, but bilateral intravitreal dexamethasone implants (Ozurdex) resolved visual disturbances and normalized ERG. Over ten years, eight MAR recurrences occurred - each treated successfully with Ozurdex - without melanoma relapse.

MAR can be presented as the first sign of melanoma relapse. This case underscores MAR's potential for recurrence despite durable melanoma remission and highlights intravitreal dexamethasone as an effective long-term therapy. The absence of autoantibodies and late flares challenges current diagnostic paradigms, emphasizing ERG's critical role. Proactive ophthalmologic surveillance and individualized local therapy canpreserve vision in this underrecognized condition.