A 77-year-old man was referred to our hospital with blurred vision in May 2009. He was diagnosed with lung small cell carcinoma in October 2008, and received chemotherapy from December 2008 at our Department of Internal Medicine.
On initial examination, his corrected visual acuity was 20/20 OD and 20/25 OS. The anterior chamber was not inflamed, but numerous snowball-like vitreous opacities, optic neuritis, and periphlebitis were observed in both eyes (Figure 3A and B). Fluorescein angiography showed dye leakage from the optic discs and along the retinal veins in both eyes (Figure 3C and D).
The results of laboratory examinations were essentially normal. Neuron-specific enolase, progastrin-releasing peptide, and markers of lung small cell carcinoma were normal in the serum. The patient was weakly positive for tuberculin. A chest x-ray did not show bilateral hilar lymphadenopathy. A computed tomography scan of the chest showed that the original focus of the lung small cell carcinoma had disappeared after chemotherapy. Cerebral magnetic resonance did not detect any abnormalities. Thus, the attending physician considered that the probability of metastasis was low. Examinations according to the criteria of sarcoidosis were negative, and tuberculosis was ruled out, as in case 1.
The vitreous opacities in both eyes had increased a month later, and his corrected visual acuity was reduced to 6/20 OD and 6/10 OS. Therefore, he underwent pars plana