Paraneoplastic vitelliform retinopathy successfully treated with intravitreal dexamethasone implants

To report a rare case of paraneoplastic vitelliform retinopathy, characterized by detachments of the retinal pigment epithelium and neurosensory retina manifesting as vitelliform lesions, successfully managed with a sustained-release intravitreal dexamethasone implant in a patient receiving systemic immunotherapy for metastatic cutaneous melanoma.

A 79-year-old man presented with progressive bilateral visual loss and serous retinal detachment. Multimodal retinal imaging revealed bilateral vitelliform lesions, choroidal thickening, and subretinal fluid. Electroretinography demonstrated an electronegative waveform, supporting the diagnosis of a condition in the spectrum of MAR. Systemic evaluation revealed axillary melanoma metastasis confirmed by fine-needle aspiration. Despite treatment with systemic pembrolizumab and a trial of intravitreal anti-VEGF injections, visual symptoms and subretinal fluid persisted. Bilateral intravitreal dexamethasone implants led to marked anatomical and functional improvement within one month, with sustained benefits observed over a two-year follow-up.

This case highlights the potential role of local corticosteroid therapy in paraneoplastic vitelliform lesions secondary to metastatic melanoma, particularly when systemic immunosuppression is contraindicated.