Correlation Between Optical Coherence Tomography (OCT) and Serum Indirect Immunofluorescence Findings in a Case of Cancer Associated Retinopathy (CAR) Masquerading as White Dot Syndrome.

Purpose: To describe a clinicopathological correlation between optical coherence tomography (OCT) and serum immunofluorescence in a case of cancer associated retinopathy (CAR) masquerading as white dot syndrome.

Methods: A retrospective case report.

Results: A 72-year-old man with a visual acuity of 20/20 in both eyes presented with white dots in the left eye. OCT showed hyperreflectivity of the outer plexiform (OPL) and nuclear layers (ONL). Fluorescein angiography showed hyperfluorescent dots, which were not visible on indocyanine green angiography. The visual field was constricted in both eyes. A global electroretinogram confirmed the diagnosis of CAR. Positron emission tomography and biopsy showed prostatic neuroendocrine carcinoma. Anti-Hu antibodies were positive, anti-recoverin antibodies were negative. Immunofluorescence of the patient's serum on a monkey retina showed antibodies marking the OPL, the ONL and the inner segment of photoreceptors with a significant correlation with OCT findings. Macular edema occurred with diffuse peripheral retinal atrophy. CAR was sequentially treated with oral corticosteroids, polyvalent immunoglobulins, intravitreal injection of dexamethasone implant and cyclophosphamide. At one-year, visual acuity was 20/20 in both eyes. The visual field remained severely constricted in both eyes.

Conclusion: CAR masquerading as white dot syndrome is a very rare entity. The correlation between OCT and immunofluorescence was remarkable in our case.