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Klin Monbl Augenheilkd 2011; 228(7): 586-592
DOI: 10.1055/s-0031-1273474
Übersicht

© Georg Thieme Verlag KG Stuttgart · New York

Intraokulare Manifestationen bei systemischen Tumorerkrankungen

Intraocular Manifestations of Systemic NeoplasmsN. E. Bechrakis1 , G. Haas1 , G. Blatsios1
  • 1Department of Ophthalmology, Innsbruck Medical University, Innsbruck, Austria
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Publikationsverlauf

Eingegangen: 14.4.2011

Angenommen: 10.6.2011

Publikationsdatum:
07. Juli 2011 (online)

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Zusammenfassung

Bei Patienten mit systemischen Tumorerkrankungen besteht eine Vielzahl von möglichen intraokulären Manifestationen. An erster Stelle stehen Metastasen in die Aderhaut, Retina und den Glaskörper von Karzinomen, Melanomen und Lymphomen. Beim von-Hippel-Lindau-Syndrom, der familiären adenomatösen Polyposis coli (FAP), dem Gardner- und Turcot-Syndrom ist die ophthalmologische Primärdiagnostik grundlegend für die Einleitung von Screening-Untersuchungen zum Ausschluss von systemischen Neoplasien (zerebelläres, spinales Hämangioblastom bzw. Nierenzell- und Kolonkarzinom) erforderlich. Weiters gibt es eine Reihe von seltenen paraneoplastischen Syndromen wie die tumor- bzw. melanomassoziierte Retinopathie (CAR, MAR), der paraneoplastischen Optikusneuropathie (PON) sowie die bilaterale diffuse uveale melanozytäre Proliferation (BDUMP), deren Therapien jedoch meistens limitiert und frustran sind.

Abstract

There are multiple possible intraocular manifestations in patients with systemic neoplasms. At first line there are uveal, retinal and vitreous metastases from carcinomas, melanomas and lymphomas. In patients with von Hippel Lindau syndrome or familiar adenomatous polyposis coli (FAP), Gardner or Turcot syndromes, fundus examinations can help in the primary diagnosis and thereby facilitate the early detection of systemic neoplasms such as cerebral and spinal haemangioblastoma, kidney or bowel cancer. Furthermore there are rare ocular paraneoplastic syndromes such as the cancer- or melanoma-associated retinopathies (CAR/MAR), the paraneoplastic optic neuropathy (PON) and the bilateral diffuse melanocytic proliferation (BDUMP) that develop secondary to systemic malignancies and can be the primary manifestation.

Schlüsselwörter

Chorioidea - Retina - okuläre Tumoren

Key words

choroid - retina - ocular tumours

Literatur

  • 1 Kreusel K M, Bechrakis N, Wiegel T et al. Clinical characteristics of choroidal metastasis.  Ophthalmologe. 2003;  100 618-622
    Suche in Google Scholar
  • 2 Shields C L, Shields J A, Gross N E et al. Survey of 520 eyes with uveal metastases.  Ophthalmology. 1997;  104 1265-1276
    Suche in Google Scholar
  • 3 Alm A, Bill A, Young F A. The effects of pilocarpine and neostigmine on the blood flow through the anterior uvea in monkeys. A study with radioactively labelled microspheres.  Experimental eye research. 1973;  15 31-36
    Suche in Google Scholar
  • 4 Lee J, Lee S, Sohn J et al. Clinical features of uveal metastases in Korean patients.  Retina. 2003;  23 491-494
    Suche in Google Scholar
  • 5 Wiegel T, Kreusel K M, Bornfeld N et al. Frequency of asymptomatic choroidal metastasis in patients with disseminated breast cancer: results of a prospective screening programme.  The British journal of ophthalmology. 1998;  82 1159-1161
    Suche in Google Scholar
  • 6 Demirci H, Shields C L, Chao A N et al. Uveal metastasis from breast cancer in 264 patients.  American journal of ophthalmology. 2003;  136 264-271
    Suche in Google Scholar
  • 7 Lemke A J, Hosten N, Wiegel T et al. Intraocular metastases: differential diagnosis from uveal melanomas with high-resolution MRI using a surface coil.  Eur Radiol. 2001;  11 2593-2601
    Suche in Google Scholar
  • 8 Lemke A J, Hosten N, Bornfeld N et al. Uveal melanoma: correlation of histopathologic and radiologic findings by using thin-section MR imaging with a surface coil.  Radiology. 1999;  210 775-783
    Suche in Google Scholar
  • 9 Krause L, Bechrakis N E, Kreusel K M et al. Indocyanine green angiography in choroid metastases.  Ophthalmologe. 2002;  99 617-619
    Suche in Google Scholar
  • 10 Natesh S, Chin K J, Finger P T. Choroidal Metastases Fundus Autofluorescence Imaging: Correlation to Clinical, OCT, and Fluorescein Angiographic Findings.  Ophthalmic Surg Lasers Imaging. 2010;  in press, online first
    Suche in Google Scholar
  • 11 Ishida T, Ohno-Matsui K, Kaneko Y et al. Fundus autofluorescence patterns in eyes with primary intraocular lymphoma.  Retina. 2010;  30 23-32
    Suche in Google Scholar
  • 12 Perez-Alvarez M J, Arriola-Villalobos P, Reche-Frutos J et al. Choroidal metastasis from a breast carcinoma. Diagnosis and follow-up with optical coherence tomography and fluorescein angiography and autofluorescence with HRA-II (Heidelberg Retina Angiograph).  Arch Soc Esp Oftalmol. 2009;  84 267-270
    Suche in Google Scholar
  • 13 Collet L C, Pulido J S, Gunduz K et al. Fundus autofluorescence in choroidal metastatic lesions: a pilot study.  Retina. 2008;  28 1251-1256
    Suche in Google Scholar
  • 14 Ishida T, Ohno-Matsui K, Kaneko Y et al. Autofluorescence of metastatic choroidal tumor.  Int Ophthalmol. 2009;  29 309-313
    Suche in Google Scholar
  • 15 Bechrakis N E, Foerster M H, Bornfeld N. Biopsy in indeterminate intraocular tumors.  Ophthalmology. 2002;  109 235-242
    Suche in Google Scholar
  • 16 Eide N, Syrdalen P, Walaas L et al. Fine needle aspiration biopsy in selecting treatment for inconclusive intraocular disease.  Acta Ophthalmol Scand. 1999;  77 448-452
    Suche in Google Scholar
  • 17 Fastenberg D M, Finger P T, Chess Q et al. Vitrectomy retinotomy aspiration biopsy of choroidal tumors.  American journal of ophthalmology. 1990;  110 361-365
    Suche in Google Scholar
  • 18 Foulds W S. The uses and limitations of intraocular biopsy.  Eye. 1992;  6 (Pt 1) 11-27
    Suche in Google Scholar
  • 19 Foulds W S, Lee W R, Roxburgh S T et al. Can chorio-retinal biopsy be justified?.  Trans Ophthalmol Soc U K. 1985;  104 (Pt 8) 864-868
    Suche in Google Scholar
  • 20 Jensen O A, Prause J U, Scherfig E. Transvitreal retino-choroidal biopsy of suspected malignant lesions of the choroid. Follow-up of cases over 7 years.  Acta Ophthalmol Scand. 1997;  75 409-411
    Suche in Google Scholar
  • 21 Johnston R L, Tufail A, Lightman S et al. Retinal and choroidal biopsies are helpful in unclear uveitis of suspected infectious or malignant origin.  Ophthalmology. 2004;  111 522-528
    Suche in Google Scholar
  • 22 Peyman G A. Vitrectomy retinotomy aspiration biopsy of choroidal tumors.  American journal of ophthalmology. 1991;  111 121
    Suche in Google Scholar
  • 23 Scherfig E, Prause J U, Jensen O A. Transvitreal retinochoroidal biopsy.  Graefe’s archive for clinical and experimental ophthalmology. 1989;  227 369-373
    Suche in Google Scholar
  • 24 Shanmugam M P, Biswas J. Fine needle aspiration biopsy in the diagnosis of intraocular mass lesions.  Indian J Ophthalmol. 1997;  45 105-108
    Suche in Google Scholar
  • 25 Accuracy of diagnosis of choroidal melanomas in the Collaborative Ocular Melanoma Study. COMS report no. 1.  Archives of ophthalmology. 1990;  108 1268-1273
    Suche in Google Scholar
  • 26 Wiegel T, Bottke D, Kreusel K M et al. External beam radiotherapy of choroidal metastases – final results of a prospective study of the German Cancer Society (ARO 95 – 08).  Radiother Oncol. 2002;  64 13-18
    Suche in Google Scholar
  • 27 Coupland S E, Damato B. Understanding intraocular lymphomas.  Clin Experiment Ophthalmol. 2008;  36 564-578
    Suche in Google Scholar
  • 28 Karma A, Willebrand E O, Tommila P V et al. Primary intraocular lymphoma: improving the diagnostic procedure.  Ophthalmology. 2007;  114 1372-1377
    Suche in Google Scholar
  • 29 Choi J Y, Kafkala von C, Foster C S. Primary intraocular lymphoma: A review.  Semin Ophthalmol. 2006;  21 125-133
    Suche in Google Scholar
  • 30 Coupland S E, Heimann H, Bechrakis N E. Primary intraocular lymphoma: a review of the clinical, histopathological and molecular biological features.  Graefe’s archive for clinical and experimental ophthalmology. 2004;  242 901-913
    Suche in Google Scholar
  • 31 Chan C C, Buggage R R, Nussenblatt R B. Intraocular lymphoma.  Current opinion in ophthalmology. 2002;  13 411-418
    Suche in Google Scholar
  • 32 Coupland S E, Foss H D, Bechrakis N E et al. Secondary ocular involvement in systemic „memory” B-cell lymphocytic leukemia.  Ophthalmology. 2001;  108 1289-1295
    Suche in Google Scholar
  • 33 Gill M K, Jampol L M. Variations in the presentation of primary intraocular lymphoma: case reports and a review.  Survey of ophthalmology. 2001;  45 463-471
    Suche in Google Scholar
  • 34 Akpek E K, Ahmed I, Hochberg F H et al. Intraocular-central nervous system lymphoma: clinical features, diagnosis, and outcomes.  Ophthalmology. 1999;  106 1805-1810
    Suche in Google Scholar
  • 35 Gunduz K, Pulido J S, McCannel C A et al. Ocular manifestations and treatment of central nervous system lymphomas.  Neurosurg Focus. 2006;  21 E9
    Suche in Google Scholar
  • 36 Jahnke K, Korfel A, Komm J et al. Intraocular lymphoma 2000 – 2005: results of a retrospective multicentre trial.  Graefe’s archive for clinical and experimental ophthalmology. 2006;  244 663-669
    Suche in Google Scholar
  • 37 Malinowski S M. The vitreous trap: a simple, surgeon-controlled technique for obtaining undiluted vitreous and subretinal specimens during pars plana vitrectomy.  Retina. 2010;  30 828-829
    Suche in Google Scholar
  • 38 Gonzales J A, Chan C C. Biopsy techniques and yields in diagnosing primary intraocular lymphoma.  Int Ophthalmol. 2007;  27 241-250
    Suche in Google Scholar
  • 39 Coupland S E, Bechrakis N E, Anastassiou G et al. Evaluation of vitrectomy specimens and chorioretinal biopsies in the diagnosis of primary intraocular lymphoma in patients with Masquerade syndrome.  Graefe’s archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv für klinische und experimentelle Ophthalmologie. 2003;  241 860-870
    Suche in Google Scholar
  • 40 Levy-Clarke G A, Byrnes G A, Buggage R R et al. Primary intraocular lymphoma diagnosed by fine needle aspiration biopsy of a subretinal lesion.  Retina. 2001;  21 281-284
    Suche in Google Scholar
  • 41 Pavan P R, Oteiza E E, Margo C E. Ocular lymphoma diagnosed by internal subretinal pigment epithelium biopsy.  Archives of ophthalmology. 1995;  113 1233-1234
    Suche in Google Scholar
  • 42 Gordon K B, Rugo H S, Duncan J L et al. Ocular manifestations of leukemia: leukemic infiltration versus infectious process.  Ophthalmology. 2001;  108 2293-2300
    Suche in Google Scholar
  • 43 Kuwabara T. Leukemic Miliary Nodules in the Retina.  Archives of ophthalmology. 1964;  72 494-497
    Suche in Google Scholar
  • 44 Jackson N, Reddy S C, Hishamuddin M et al. Retinal findings in adult leukaemia: correlation with leukocytosis.  Clin Lab Haematol. 1996;  18 105-109
    Suche in Google Scholar
  • 45 Leach M J. Images in clinical medicine. Retinal hemorrhages in acute leukemia.  N Engl J Med. 2002;  346 e6
    Suche in Google Scholar
  • 46 Kassam F, Gale J S, Sheidow T G. Intraocular leukemia as the primary manifestation of relapsing acute myelogenous leukemia.  Canadian journal of ophthalmology. 2003;  38 613-616
    Suche in Google Scholar
  • 47 Chakraborty P P, Mandal S K, Bandyopadhyay D et al. Roth’s spots as an only sign of acute myeloid leukemia.  J Assoc Physicians India. 2006;  54 547
    Suche in Google Scholar
  • 48 Zhang Y Q, Wang W J. Treatment outcomes after pars plana vitrectomy for endogenous endophthalmitis.  Retina. 2005;  25 746-750
    Suche in Google Scholar
  • 49 Fries B C, Riddell S R, Kim H W et al. Cytomegalovirus disease before hematopoietic cell transplantation as a risk for complications after transplantation.  Biol Blood Marrow Transplant. 2005;  11 136-148
    Suche in Google Scholar
  • 50 Coskuncan N M, Jabs D A, Dunn J P et al. The eye in bone marrow transplantation. VI. Retinal complications.  Archives of ophthalmology. 1994;  112 372-379
    Suche in Google Scholar
  • 51 Allione A, Montanaro M, Marmont F et al. Fungal endophthalmitis in acute leukaemia.  Br J Haematol. 2004;  124 257
    Suche in Google Scholar
  • 52 Machado Od Ode O, Goncalves R, Fernandes E M et al. Bilateral Aspergillus endophthalmitis in a patient with chronic lymphocytic leukaemia.  The British journal of ophthalmology. 2003;  87 1429-1430
    Suche in Google Scholar
  • 53 Song W K, Min Y H, Kim Y R et al. Cytomegalovirus retinitis after hematopoietic stem cell transplantation with alemtuzumab.  Ophthalmology. 2008;  115 1766-1770
    Suche in Google Scholar
  • 54 Kerrison J B. Neuro-ophthalmology of the phacomatoses.  Current opinion in ophthalmology. 2000;  11 413-420
    Suche in Google Scholar
  • 55 Kreusel K M, Krause L, Graul-Neumann L et al. Family screening in patients with retinal angiomatosis.  Klin Monatsbl Augenheilkd. 2009;  226 939-943
    Suche in Google Scholar
  • 56 Kreusel K M, Bechrakis N E, Neumann H P et al. Solitary juxtapapillary capillary retinal angioma and von Hippel-Lindau disease.  Canadian journal of ophthalmology. 2007;  42 251-255
    Suche in Google Scholar
  • 57 Kreusel K M, Bechrakis N E, Neumann H P et al. Juxtapapillary capillary retinal angioma with epiretinal membrane of the macula in familial Von-Hippel-Lindau-Syndrome.  Ophthalmologe. 2007;  104 317-320
    Suche in Google Scholar
  • 58 Kreusel K M, Bechrakis N E, Krause L et al. Retinal angiomatosis in von Hippel-Lindau disease: a longitudinal ophthalmologic study.  Ophthalmology. 2006;  113 1418-1424
    Suche in Google Scholar
  • 59 Kreusel K M, Bechrakis N E, Heinichen T et al. Retinal angiomatosis and von Hippel-Lindau disease.  Graefe’s archive for clinical and experimental ophthalmology. 2000;  238 916-921
    Suche in Google Scholar
  • 60 Maher E R, Yates J R, Harries R et al. Clinical features and natural history of von Hippel-Lindau disease.  The Quarterly journal of medicine. 1990;  77 1151-1163
    Suche in Google Scholar
  • 61 Bisgaard M L, Bulow S. Familial adenomatous polyposis (FAP): genotype correlation to FAP phenotype with osteomas and sebaceous cysts.  Am J Med Genet A. 2006;  140 200-204
    Suche in Google Scholar
  • 62 Traboulsi E I. Ocular manifestations of familial adenomatous polyposis (Gardner syndrome).  Ophthalmol Clin North Am. 2005;  18 163-166, x
    Suche in Google Scholar
  • 63 Meyer C H, Becker R, Schmidt J C et al. When is congenital hypertrophy of the retinal pigment epithelium (CHRPE) associated with the Gardner’s syndrome? An overview with clinical examples.  Klin Monatsbl Augenheilkd. 2002;  219 644-648
    Suche in Google Scholar
  • 64 Ballhausen W G. Genetic testing for familial adenomatous polyposis.  Ann N Y Acad Sci. 2000;  910 36-47 ; discussion 47 – 39
    Suche in Google Scholar
  • 65 Tiret A, Parc C. Fundus lesions of adenomatous polyposis.  Current opinion in ophthalmology. 1999;  10 168-172
    Suche in Google Scholar
  • 66 Tiret A, Taiel-Sartral M, Tiret E et al. Diagnostic value of fundus examination in familial adenomatous polyposis.  The British journal of ophthalmology. 1997;  81 755-758
    Suche in Google Scholar
  • 67 Munden P M, Sobol W M, Weingeist T A. Ocular findings in Turcot syndrome (glioma-polyposis).  Ophthalmology. 1991;  98 111-114
    Suche in Google Scholar
  • 68 Traboulsi E I, Maumenee I H, Krush A J et al. Pigmented ocular fundus lesions in the inherited gastrointestinal polyposis syndromes and in hereditary nonpolyposis colorectal cancer.  Ophthalmology. 1988;  95 964-969
    Suche in Google Scholar
  • 69 Gomez Garcia E B, Knoers N V. Gardner’s syndrome (familial adenomatous polyposis): a cilia-related disorder.  Lancet Oncol. 2009;  10 727-735
    Suche in Google Scholar
  • 70 Jacobzone C, Cochard-Marianowski C, Kupfer I et al. Corticosteroid treatment for melanoma-associated retinopathy: effect on visual acuity and electrophysiologic findings.  Arch Dermatol. 2004;  140 1258-1261
    Suche in Google Scholar
  • 71 Adamus G. Autoantibody targets and their cancer relationship in the pathogenicity of paraneoplastic retinopathy.  Autoimmun Rev. 2009;  8 410-414
    Suche in Google Scholar
  • 72 Ling C P, Pavesio C. Paraneoplastic syndromes associated with visual loss.  Current opinion in ophthalmology. 2003;  14 426-432
    Suche in Google Scholar
  • 73 Gass J D, Gieser R G, Wilkinson C P et al. Bilateral diffuse uveal melanocytic proliferation in patients with occult carcinoma.  Archives of ophthalmology. 1990;  108 527-533
    Suche in Google Scholar
  • 74 Brüggemann A, Bülow von M, Finas D et al. Bilateral diffuse uveal melanocytic proliferation associated with the recurrence of a Bartholin gland carcinoma.  The British journal of ophthalmology. 2011;  in press, online first
    Suche in Google Scholar
  • 75 Mandelcorn E, McGuire K, Dixon W et al. Ocular paraneoplastic syndrome: a case of bilateral diffuse uveal melanocytic proliferation.  Retina. 2009;  29 1375-1376
    Suche in Google Scholar
  • 76 Ritland J S, Eide N, Tausjo J. Bilateral diffuse uveal melanocytic proliferation and uterine cancer. A case report.  Acta Ophthalmol Scand. 2000;  78 366-368
    Suche in Google Scholar

Prof. Dr. Nikolaos E. Bechrakis

Direktor der Univ.-Augenklinik, Medizinische Universität Innsbruck

Anichstr. 35

6020 Innsbruck

Österreich

Telefon: ++ 43/5 12/50 42 37 20

Fax: ++ 43/5 12/50 42 37 22

eMail: nikolaos.bechrakis@i-med.ac.at