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CASE REPORT article

Front. Med.
Sec. Ophthalmology
Volume 11 - 2024 | doi: 10.3389/fmed.2024.1445180

Case Report: Longitudinal Evaluation and Treatment of a Melanoma-Associated Retinopathy Patient

Provisionally accepted
Ryan M. Mosavi-Hecht Ryan M. Mosavi-Hecht 1Paul Yang Paul Yang 2Barrett Heyer Barrett Heyer 1Christopher R. Rosenberg Christopher R. Rosenberg 2Elizabeth White Elizabeth White 2Elizabeth G. Berry Elizabeth G. Berry 1Robert M. Duvoisin Robert M. Duvoisin 1Catherine Morgans Catherine Morgans 1,2*
  • 1 Oregon Health and Science University, Portland, United States
  • 2 Casey Eye Institute, School of Medicine, Oregon Health and Science University, Portland, Oregon, United States

The final, formatted version of the article will be published soon.

    Melanoma-associated retinopathy (MAR) is a paraneoplastic syndrome associated with cutaneous metastatic melanoma in which patients develop vision deficits that include reduced night vision, poor contrast sensitivity, and photopsia. MAR is caused by autoantibodies targeting TRPM1, an ion channel found in melanocytes and retinal ON-bipolar cells (ON-BCs). The visual symptoms arise when TRPM1 autoantibodies enter ON-BCs and block the function of TRPM1, thus detection of TRPM1 autoantibodies in patient serum is a key criterion in diagnosing MAR. Electroretinograms are used to measure the impact of TRPM1 autoantibodies on ON-BC function and represent another important diagnostic tool for MAR. To date, MAR case reports have included one or both diagnostic components, but only for a single time point in the course of a patient’s disease. Here, we report a case of MAR supported by longitudinal analysis of serum autoantibody detection, visual function, ocular inflammation, vascular integrity, and response to slow-release intraocular corticosteroids. Integrating these data with the patient’s oncological and ophthalmological records reveals novel insights regarding MAR pathogenesis, progression, and treatment, which may inform new research and expand our collective understanding of the disease. In brief, we find TRPM1 autoantibodies can disrupt vision even when serum levels are barely detectable by western blot and immunohistochemistry; intraocular dexamethasone treatment alleviates MAR visual symptoms despite high levels of circulating TRPM1 autoantibodies, implicating antibody access to the retina as a key factor in MAR pathogenesis. Elevated inflammatory cytokine levels in the patient’s eyes may be responsible for the observed damage to the blood-retinal barrier and subsequent entry of autoantibodies into the retina.

    Keywords: Melanoma, Mar, Autoantibodies, bipolar cells, Retina, TRPM1, Autoimmune retinopathy, Paraneoplastic syndrome

    Received: 06 Jun 2024; Accepted: 26 Aug 2024.

    Copyright: © 2024 Mosavi-Hecht, Yang, Heyer, Rosenberg, White, Berry, Duvoisin and Morgans. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Catherine Morgans, Oregon Health and Science University, Portland, United States

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