Paraneoplastic Disease (PowerPoint)

This 46-year-old woman noted progressive bilateral visual loss over a 10-month period. She had a malignant melanoma removed from her right thigh 2 years ago and excisional biopsy of an inguinal node metastasis 8 months ago. She also complained of poor night vision and rare intermittent ""sparkles"" in her visual field. The serum titers were positive for antiretinal antibodies. The fundus photographs show temporal disc pallor and vascular attenuation (Images 92_23 and 92_24). The fields demonstrate large central scotoma in both eyes (extending centrocecally in the right eye) as well as some early loss in the upper and lower arcuate areas (Images 92_25 and 92_26).