- Email: [email protected]
The relation of coffee and caffeine to the 5-year incidence of early age-related maculopathy: the beaver dam eye study
FIGURE 2. (Left) Angiography discloses a sacciform aneurysm of the supraclinoidal left internal carotid artery located close to the ophthalmic branch. The aneurysm measured 1.7 ⴛ 1.5 ⴛ 1.7 cm. (Right) Three-dimensional reconstruction of the aneurysm.
REFERENCES
1. Lang GE, Spraul CW. Risk factors for retinal occlusive diseases. Klin Monatsbl Augenheilkd 1997;211:217–226. 2. Kimura K, Hashimoto Y, Ohno H, Uchino M, Andro M. Carotid artery disease in patients with retinal artery occlusion. Intern Med 1996;35:937–940. 3. Greven CM, Slusher MM, Weaver RG. Retinal arterial occlusion in young adults. Am J Ophthalmol 1995;120:776 – 783. 4. Castillo B, De Alba F, Thornton, J, DeBrun G, Pulido J. Retinal artery occlusion following coil embolization of carotid-ophthalmic aneurysms. Arch Ophthalmol 2000;118:851– 852.
The Relation of Coffee and Caffeine to the 5-Year Incidence of Early Age-Related Maculopathy: The Beaver Dam Eye Study
A
GE-RELATED MACULOPATHY IS ASSOCIATED WITH
BRIEF REPORTS
271
Sandra C. Tomany, MS, Ronald Klein, MD, and Barbara E. K. Klein, MD PURPOSE:
To examine the relationship between coffee and caffeine consumption and the 5-year incidence of
Accepted for publication Jan 16, 2001. From the Department of Ophthalmology and Visual Sciences, University of Wisconsin Medical School, Madison. Supported by Grant EY06594 from the National Institutes of Health, Bethesda, Maryland (Drs. R. Klein and B.E.K. Klein) and in part by the Senior Scientific Investigator Award from Research to Prevent Blindness, New York (Dr. R. Klein). Inquiries to Ronald Klein, MD, MPH, Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, 610 North Walnut St, 460 WARF, Madison, WI 53705-2397; fax: (608) 263-0279; e-mail: [email protected]
VOL. 132, NO. 2
early age-related maculopathy and its component lesions, soft indistinct drusen or pigmentary abnormalities. DESIGN: A prospective cohort study conducted from 1988 to 1995 with an average follow-up of 4.8 years. METHODS: Data from baseline and 5-year follow-up examinations were analyzed for Beaver Dam Eye Study participants (n ⴝ 3435). The Wisconsin Age-Related Maculopathy Grading System was used to assess the presence and severity of early age-related maculopathy. RESULTS: Men were more likely to be coffee and caffeine drinkers than were women. For both men and women, coffee and caffeine intake decreased with age. Coffee and caffeine consumption were not associated with the 5-year incidence of early age-related maculopathy, soft indistinct drusen, or pigmentary abnormalities. CONCLUSION: Neither a history of coffee nor caffeine consumption is associated with incident early age-related maculopathy. (Am J Ophthalmol 2001;132:271–273. © 2001 by Elsevier Science Inc. All rights reserved.)
visual loss and occurs after a lifetime of exposure to potentially causative agents, some of which represent chosen behaviors.1,2 Cross-sectional and prospective studies have found positive associations between cigarette smoking and early and late stages of age-related maculopathy.2 To our knowledge, there are no data relating caffeine exposure to age-related maculopathy. Caffeine exposure is common, and caffeine is metabolically active. The purpose of this brief report is to examine the relationship of coffee and caffeine intake to the 5-year incidence of early age-related maculopathy and its component lesions, soft drusen and pigmentary abnormalities.
TABLE 1. Relation of Coffee and Caffeine Consumption at Baseline to Age- and Smoking-Adjusted 5-year Incidence* of Age-Related Maculopathy by Sex in the Beaver Dam Eye Study, 1988 –1990 Coffee Consumption and Incidence of Early ARM
No.
Adjusted Rate†
OR‡
Caffeine Consumption and Incidence of Early ARM
P§
No.
Adjusted Rate†
OR‡
95% CI
P§
0.41–1.33 0.48–1.42
0.31 0.49
227 297 665
8.5% 8.8% 8.7%
1.00 0.84 0.93
0.44–1.60 0.53–1.62
0.59 0.78
0.40–1.47 0.54–1.90 0.66–2.63 Women
0.42 0.97 0.44
524 293 211 161
8.6% 7.2% 8.1% 11.4%
1.00 0.86 1.14 1.24
0.49–1.52 0.61–2.11 0.61–2.53
0.61 0.68 0.55
95% CI
Men Overall consumption None Past Current Cups per day 0 1–2 3–4 5⫹ Overall consumption None Past Current Cups per day 0 1–2 3–4 5⫹
269 371 549
9.6% 7.4% 8.0%
1.00 0.74 0.83
640 200 202 147
8.3% 5.9% 7.5% 11.7%
1.00 0.76 1.01 1.32
404 521 588
10.5% 12.8% 11.7%
1.00 0.97 0.95
0.63–1.51 0.60–1.50
0.89 0.83
320 485 728
11.0% 11.7% 11.6%
1.00 1.03 1.04
0.64–1.65 0.65–1.64
0.91 0.88
945 209 236 143
11.4% 9.3% 12.1% 12.6%
1.00 0.88 0.99 1.11
0.44–1.41 0.50–1.55 0.58–1.68 0.54–2.26
0.66 0.96 0.78
805 326 247 155
11.4% 9.8% 13.0% 13.8%
1.00 0.96 1.02 1.19
0.60–1.54 0.60–1.73 0.60–2.39
0.88 0.95 0.62
ARM ⫽ age-related maculopathy; CI ⫽ confidence interval. *Incidence is defined as the cumulative incidence of a lesion at the follow-up examination among subjects without lesions at the baseline. † Adjusted by age and smoking status. ‡ Odds ratio, controlling for age and smoking status. § P-value for logistic regression, controlling for age and smoking status.
Methods used to identify the population and descriptions of the population have appeared previously.3 In brief, a private census of the population of Beaver Dam, Wisconsin, was performed to identify all persons 43 to 84 years of age. The baseline examination occurred between March 1, 1988, and September 14, 1990 (n ⫽ 4926). There were 3684 persons who participated in the follow-up examination from March 1, 1993, through June 14, 1995. Data from the participants at both baseline and this 5-year follow-up form the basis for this report. Institutional review board approval was granted, and informed consent obtained in accordance with the Declaration of Helsinki. The Wisconsin Age-Related Maculopathy Grading System was used to assess the presence and severity of lesions associated with age-related maculopathy. Grading procedures, lesion descriptions, and definitions of the presence and severity of these lesions appear elsewhere.3 Incidence of early age-related maculopathy was defined by the presence of either soft indistinct drusen or of any type of drusen associated with retinal pigment epithelial depigmentation or increased retinal pigmentation at follow-up when none of the lesions were present at baseline. Analyses were performed using SAS. 272
AMERICAN JOURNAL
Coffee intake was defined as current number of cups consumed per day (0 cups per day, 1 to 2 cups per day, 3 to 4 cups per day, 5 or more cups per day) and as overall coffee consumption (never, past, present). Caffeine consumption (coffee, tea, or other caffeinated beverages) was categorized similarly, converting the milligrams of caffeine consumed per day into their coffee equivalent (e.g., 103-mg caffeine ⫽ one cup coffee ⫽ one serving caffeine). Younger participants (n ⫽ 322, 21.4%) were more likely to be heavy coffee drinkers (five or more cups per day) than were older participants (n ⫽ 366, 18.9%, p ⫽ 0.07). As age increased, the proportion of non-coffee drinkers also increased (p-test of trend ⬍ 0.01). Men (n ⫽ 1151, 76.7%) were more likely to classify themselves as current or past coffee drinkers than were women (n ⫽ 1433, 74.1%, p ⫽ 0.09). Because coffee and caffeine consumption differed by gender and age, men and women of various age groups were examined separately in further analyses. Table 1 shows the results of logistic regression by gender and adjusted for age and cigarette smoking status. No statistically significant associations were found between coffee or caffeine consumption and incidence of early OF
OPHTHALMOLOGY
AUGUST 2001
age-related maculopathy (Table 1), soft indistinct drusen, or pigmentary abnormalities (data not shown). Lotfi and Grunwald4 previously demonstrated a vasoconstrictive effect of caffeine intake, as manifested by a 13% reduction in the mean velocity of white blood cells in the retinal capillary circulation in the macula. Grunwald and others have reported alterations in choroidal blood flow in persons with age-related maculopathy and have hypothesized that these alterations in blood flow may have a role in the pathogenesis of age-related maculopathy.5 We hypothesized that caffeine may be associated with early age-related maculopathy through a possible vasoconstrictive effect on the retinal and choroidal circulation. Our data show that coffee or overall caffeine intake is not associated with the incidence of early age-related maculopathy or any of its defining lesions in the Beaver Dam population. ACKNOWLEDGMENTS
We wish to acknowledge Dr. Mary Frances Cotch, Dr. Mae Gordon, Dr. Lee Jampol, Dr. Dan Seigel, and Dr. Robert Wallace for their contributions to this project. REFERENCES
1. Klein R, Wang Q, Klein BEK, et al. The relationship of age-related maculopathy, cataract, and glaucoma to visual acuity. Invest Ophthalmol Vis Sci 1995;36:182–191. 2. Klein R. Epidemiology. In: Berger JW, Fine SL, Maguire MG, editors. Age-related macular degeneration. Mosby, St. Louis 1998:31–56. 3. Klein R, Klein BEK, Jensen SC, et al. The five-year incidence and progression of age-related maculopathy: the Beaver Dam Eye Study. Ophthalmology 1997;104:7–21. 4. Lotfi K, Grunwald JE. The effect of caffeine on human macular circulation. Invest Ophthalmol Vis Sci 1991;32: 3028 –3032. 5. Grunwald JE. Foveolar choroidal blood flow in age-related degeneration. Invest Ophthalmol Vis Sci 1998;39:385–390.
Retinal Findings in MelanomaAssociated Retinopathy Lisa M. Borkowski, MD, Sandeep Grover, MD, Gerald A. Fishman, MD, and Lee M. Jampol, MD PURPOSE:
To report unusual fundus findings in two cases of melanoma-associated retinopathy.
Accepted for publication Jan 22, 2001. From the Department of Ophthalmology (L.M.B., L.M.J.), Northwestern University, Chicago, Illinois, and the Department of Ophthalmology (S.G., G.A.F.), University of Illinois, Chicago, Illinois. Supported in part by an unrestricted grant from Research to Prevent Blindness (Northwestern University), New York, and The Foundation Fighting Blindness (G.A.F.), Hunt Valley, Maryland. Inquiries to Lee M. Jampol, MD, Department of Ophthalmology, Northwestern University, 645 N Michigan Ave, Ste 440, Chicago, IL 60611; fax (312) 503-8152.
VOL. 132, NO. 2
METHODS:
Observational case reports. The histories of two patients with melanoma-associated retinopathy were reviewed. Sera from both patients were examined for antibodies against retinal bipolar cells. Immunofluorescence was performed on cryostat sections of unfixed normal human retinas. Sera and IgG from both patients were tested against a known melanoma-associated retinopathy patient as well as a control subject. RESULTS: Our patients had metastatic, cutaneous melanoma and a clinical syndrome consistent with melanomaassociated retinopathy. Both patients had serum antibodies that were reactive against retinal bipolar cells. They had unusual fundus changes not previously described in association with melanoma-associated retinopathy. One patient also developed vitiligo. CONCLUSION: Patients with metastatic cutaneous melanoma and melanoma-associated retinopathy may present unusual fundus lesions that may be caused by autoimmunity which is part of the clinical picture of melanomaassociated retinopathy or metastatic melanoma. (Am J Ophthalmol 2001;132:273–275. © 2001 by Elsevier Science Inc. All rights reserved.)
M
ELANOMA-ASSOCIATED RETINOPATHY IN PATIENTS
with metastatic cutaneous malignant melanoma is associated with visual photopsias, night blindness, and the presence of serum autoantibodies to retinal bipolar cells.1– 4 Retinal findings in these patients may include optic nerve pallor and retinal arteriolar attenuation, but frequently the fundus is normal.1–3 We report two cases of melanomaassociated retinopathy with unusual retinal lesions. ● CASE 1:
A 47-year-old woman was referred February 11, 1999, with a 3-year history of decreased vision and nyctalopia in both eyes. A history of cutaneous facial melanoma existed, diagnosed in 1995. She had undergone four local excisions. Visual acuity was RE: 20/400 and LE: counting fingers at 3 ft. Her pupils were minimally reactive without an afferent pupillary defect. Slit-lamp biomicroscopy and intraocular pressures were normal. Ophthalmoscopy showed unusual round and oval-shaped white lesions at the level of the outer retina or retinal pigment epithelium (Figure 1). These lesions were scattered throughout the posterior pole and midperiphery in both eyes and involved the fovea. In the far periphery, pigmentary changes were noted. The serum of the patient was positive for autoantibodies that labeled retinal bipolar cells using an immunofluorescence technique previously described.3 The patient was unable to return for electroretinogram testing. Several months later, metastatic lesions in the brain were noted. She underwent radiation and chemotherapy, but died 2 months later. ● CASE 2:
A 57-year-old white man had a history of nyctalopia and complained of “shimmering lights.” His
BRIEF REPORTS
273
REFERENCES
1. Lang GE, Spraul CW. Risk factors for retinal occlusive diseases. Klin Monatsbl Augenheilkd 1997;211:217–226. 2. Kimura K, Hashimoto Y, Ohno H, Uchino M, Andro M. Carotid artery disease in patients with retinal artery occlusion. Intern Med 1996;35:937–940. 3. Greven CM, Slusher MM, Weaver RG. Retinal arterial occlusion in young adults. Am J Ophthalmol 1995;120:776 – 783. 4. Castillo B, De Alba F, Thornton, J, DeBrun G, Pulido J. Retinal artery occlusion following coil embolization of carotid-ophthalmic aneurysms. Arch Ophthalmol 2000;118:851– 852.
The Relation of Coffee and Caffeine to the 5-Year Incidence of Early Age-Related Maculopathy: The Beaver Dam Eye Study
A
GE-RELATED MACULOPATHY IS ASSOCIATED WITH
BRIEF REPORTS
271
Sandra C. Tomany, MS, Ronald Klein, MD, and Barbara E. K. Klein, MD PURPOSE:
To examine the relationship between coffee and caffeine consumption and the 5-year incidence of
Accepted for publication Jan 16, 2001. From the Department of Ophthalmology and Visual Sciences, University of Wisconsin Medical School, Madison. Supported by Grant EY06594 from the National Institutes of Health, Bethesda, Maryland (Drs. R. Klein and B.E.K. Klein) and in part by the Senior Scientific Investigator Award from Research to Prevent Blindness, New York (Dr. R. Klein). Inquiries to Ronald Klein, MD, MPH, Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, 610 North Walnut St, 460 WARF, Madison, WI 53705-2397; fax: (608) 263-0279; e-mail: [email protected]
VOL. 132, NO. 2
early age-related maculopathy and its component lesions, soft indistinct drusen or pigmentary abnormalities. DESIGN: A prospective cohort study conducted from 1988 to 1995 with an average follow-up of 4.8 years. METHODS: Data from baseline and 5-year follow-up examinations were analyzed for Beaver Dam Eye Study participants (n ⴝ 3435). The Wisconsin Age-Related Maculopathy Grading System was used to assess the presence and severity of early age-related maculopathy. RESULTS: Men were more likely to be coffee and caffeine drinkers than were women. For both men and women, coffee and caffeine intake decreased with age. Coffee and caffeine consumption were not associated with the 5-year incidence of early age-related maculopathy, soft indistinct drusen, or pigmentary abnormalities. CONCLUSION: Neither a history of coffee nor caffeine consumption is associated with incident early age-related maculopathy. (Am J Ophthalmol 2001;132:271–273. © 2001 by Elsevier Science Inc. All rights reserved.)
visual loss and occurs after a lifetime of exposure to potentially causative agents, some of which represent chosen behaviors.1,2 Cross-sectional and prospective studies have found positive associations between cigarette smoking and early and late stages of age-related maculopathy.2 To our knowledge, there are no data relating caffeine exposure to age-related maculopathy. Caffeine exposure is common, and caffeine is metabolically active. The purpose of this brief report is to examine the relationship of coffee and caffeine intake to the 5-year incidence of early age-related maculopathy and its component lesions, soft drusen and pigmentary abnormalities.
TABLE 1. Relation of Coffee and Caffeine Consumption at Baseline to Age- and Smoking-Adjusted 5-year Incidence* of Age-Related Maculopathy by Sex in the Beaver Dam Eye Study, 1988 –1990 Coffee Consumption and Incidence of Early ARM
No.
Adjusted Rate†
OR‡
Caffeine Consumption and Incidence of Early ARM
P§
No.
Adjusted Rate†
OR‡
95% CI
P§
0.41–1.33 0.48–1.42
0.31 0.49
227 297 665
8.5% 8.8% 8.7%
1.00 0.84 0.93
0.44–1.60 0.53–1.62
0.59 0.78
0.40–1.47 0.54–1.90 0.66–2.63 Women
0.42 0.97 0.44
524 293 211 161
8.6% 7.2% 8.1% 11.4%
1.00 0.86 1.14 1.24
0.49–1.52 0.61–2.11 0.61–2.53
0.61 0.68 0.55
95% CI
Men Overall consumption None Past Current Cups per day 0 1–2 3–4 5⫹ Overall consumption None Past Current Cups per day 0 1–2 3–4 5⫹
269 371 549
9.6% 7.4% 8.0%
1.00 0.74 0.83
640 200 202 147
8.3% 5.9% 7.5% 11.7%
1.00 0.76 1.01 1.32
404 521 588
10.5% 12.8% 11.7%
1.00 0.97 0.95
0.63–1.51 0.60–1.50
0.89 0.83
320 485 728
11.0% 11.7% 11.6%
1.00 1.03 1.04
0.64–1.65 0.65–1.64
0.91 0.88
945 209 236 143
11.4% 9.3% 12.1% 12.6%
1.00 0.88 0.99 1.11
0.44–1.41 0.50–1.55 0.58–1.68 0.54–2.26
0.66 0.96 0.78
805 326 247 155
11.4% 9.8% 13.0% 13.8%
1.00 0.96 1.02 1.19
0.60–1.54 0.60–1.73 0.60–2.39
0.88 0.95 0.62
ARM ⫽ age-related maculopathy; CI ⫽ confidence interval. *Incidence is defined as the cumulative incidence of a lesion at the follow-up examination among subjects without lesions at the baseline. † Adjusted by age and smoking status. ‡ Odds ratio, controlling for age and smoking status. § P-value for logistic regression, controlling for age and smoking status.
Methods used to identify the population and descriptions of the population have appeared previously.3 In brief, a private census of the population of Beaver Dam, Wisconsin, was performed to identify all persons 43 to 84 years of age. The baseline examination occurred between March 1, 1988, and September 14, 1990 (n ⫽ 4926). There were 3684 persons who participated in the follow-up examination from March 1, 1993, through June 14, 1995. Data from the participants at both baseline and this 5-year follow-up form the basis for this report. Institutional review board approval was granted, and informed consent obtained in accordance with the Declaration of Helsinki. The Wisconsin Age-Related Maculopathy Grading System was used to assess the presence and severity of lesions associated with age-related maculopathy. Grading procedures, lesion descriptions, and definitions of the presence and severity of these lesions appear elsewhere.3 Incidence of early age-related maculopathy was defined by the presence of either soft indistinct drusen or of any type of drusen associated with retinal pigment epithelial depigmentation or increased retinal pigmentation at follow-up when none of the lesions were present at baseline. Analyses were performed using SAS. 272
AMERICAN JOURNAL
Coffee intake was defined as current number of cups consumed per day (0 cups per day, 1 to 2 cups per day, 3 to 4 cups per day, 5 or more cups per day) and as overall coffee consumption (never, past, present). Caffeine consumption (coffee, tea, or other caffeinated beverages) was categorized similarly, converting the milligrams of caffeine consumed per day into their coffee equivalent (e.g., 103-mg caffeine ⫽ one cup coffee ⫽ one serving caffeine). Younger participants (n ⫽ 322, 21.4%) were more likely to be heavy coffee drinkers (five or more cups per day) than were older participants (n ⫽ 366, 18.9%, p ⫽ 0.07). As age increased, the proportion of non-coffee drinkers also increased (p-test of trend ⬍ 0.01). Men (n ⫽ 1151, 76.7%) were more likely to classify themselves as current or past coffee drinkers than were women (n ⫽ 1433, 74.1%, p ⫽ 0.09). Because coffee and caffeine consumption differed by gender and age, men and women of various age groups were examined separately in further analyses. Table 1 shows the results of logistic regression by gender and adjusted for age and cigarette smoking status. No statistically significant associations were found between coffee or caffeine consumption and incidence of early OF
OPHTHALMOLOGY
AUGUST 2001
age-related maculopathy (Table 1), soft indistinct drusen, or pigmentary abnormalities (data not shown). Lotfi and Grunwald4 previously demonstrated a vasoconstrictive effect of caffeine intake, as manifested by a 13% reduction in the mean velocity of white blood cells in the retinal capillary circulation in the macula. Grunwald and others have reported alterations in choroidal blood flow in persons with age-related maculopathy and have hypothesized that these alterations in blood flow may have a role in the pathogenesis of age-related maculopathy.5 We hypothesized that caffeine may be associated with early age-related maculopathy through a possible vasoconstrictive effect on the retinal and choroidal circulation. Our data show that coffee or overall caffeine intake is not associated with the incidence of early age-related maculopathy or any of its defining lesions in the Beaver Dam population. ACKNOWLEDGMENTS
We wish to acknowledge Dr. Mary Frances Cotch, Dr. Mae Gordon, Dr. Lee Jampol, Dr. Dan Seigel, and Dr. Robert Wallace for their contributions to this project. REFERENCES
1. Klein R, Wang Q, Klein BEK, et al. The relationship of age-related maculopathy, cataract, and glaucoma to visual acuity. Invest Ophthalmol Vis Sci 1995;36:182–191. 2. Klein R. Epidemiology. In: Berger JW, Fine SL, Maguire MG, editors. Age-related macular degeneration. Mosby, St. Louis 1998:31–56. 3. Klein R, Klein BEK, Jensen SC, et al. The five-year incidence and progression of age-related maculopathy: the Beaver Dam Eye Study. Ophthalmology 1997;104:7–21. 4. Lotfi K, Grunwald JE. The effect of caffeine on human macular circulation. Invest Ophthalmol Vis Sci 1991;32: 3028 –3032. 5. Grunwald JE. Foveolar choroidal blood flow in age-related degeneration. Invest Ophthalmol Vis Sci 1998;39:385–390.
Retinal Findings in MelanomaAssociated Retinopathy Lisa M. Borkowski, MD, Sandeep Grover, MD, Gerald A. Fishman, MD, and Lee M. Jampol, MD PURPOSE:
To report unusual fundus findings in two cases of melanoma-associated retinopathy.
Accepted for publication Jan 22, 2001. From the Department of Ophthalmology (L.M.B., L.M.J.), Northwestern University, Chicago, Illinois, and the Department of Ophthalmology (S.G., G.A.F.), University of Illinois, Chicago, Illinois. Supported in part by an unrestricted grant from Research to Prevent Blindness (Northwestern University), New York, and The Foundation Fighting Blindness (G.A.F.), Hunt Valley, Maryland. Inquiries to Lee M. Jampol, MD, Department of Ophthalmology, Northwestern University, 645 N Michigan Ave, Ste 440, Chicago, IL 60611; fax (312) 503-8152.
VOL. 132, NO. 2
METHODS:
Observational case reports. The histories of two patients with melanoma-associated retinopathy were reviewed. Sera from both patients were examined for antibodies against retinal bipolar cells. Immunofluorescence was performed on cryostat sections of unfixed normal human retinas. Sera and IgG from both patients were tested against a known melanoma-associated retinopathy patient as well as a control subject. RESULTS: Our patients had metastatic, cutaneous melanoma and a clinical syndrome consistent with melanomaassociated retinopathy. Both patients had serum antibodies that were reactive against retinal bipolar cells. They had unusual fundus changes not previously described in association with melanoma-associated retinopathy. One patient also developed vitiligo. CONCLUSION: Patients with metastatic cutaneous melanoma and melanoma-associated retinopathy may present unusual fundus lesions that may be caused by autoimmunity which is part of the clinical picture of melanomaassociated retinopathy or metastatic melanoma. (Am J Ophthalmol 2001;132:273–275. © 2001 by Elsevier Science Inc. All rights reserved.)
M
ELANOMA-ASSOCIATED RETINOPATHY IN PATIENTS
with metastatic cutaneous malignant melanoma is associated with visual photopsias, night blindness, and the presence of serum autoantibodies to retinal bipolar cells.1– 4 Retinal findings in these patients may include optic nerve pallor and retinal arteriolar attenuation, but frequently the fundus is normal.1–3 We report two cases of melanomaassociated retinopathy with unusual retinal lesions. ● CASE 1:
A 47-year-old woman was referred February 11, 1999, with a 3-year history of decreased vision and nyctalopia in both eyes. A history of cutaneous facial melanoma existed, diagnosed in 1995. She had undergone four local excisions. Visual acuity was RE: 20/400 and LE: counting fingers at 3 ft. Her pupils were minimally reactive without an afferent pupillary defect. Slit-lamp biomicroscopy and intraocular pressures were normal. Ophthalmoscopy showed unusual round and oval-shaped white lesions at the level of the outer retina or retinal pigment epithelium (Figure 1). These lesions were scattered throughout the posterior pole and midperiphery in both eyes and involved the fovea. In the far periphery, pigmentary changes were noted. The serum of the patient was positive for autoantibodies that labeled retinal bipolar cells using an immunofluorescence technique previously described.3 The patient was unable to return for electroretinogram testing. Several months later, metastatic lesions in the brain were noted. She underwent radiation and chemotherapy, but died 2 months later. ● CASE 2:
A 57-year-old white man had a history of nyctalopia and complained of “shimmering lights.” His
BRIEF REPORTS
273