Case Report: Asymmetric Visual Field Progression in Melanoma-Associated Retinopathy Heralding Recurrent Malignancy.

Purpose: To report a case of asymmetric melanoma-associated retinopathy (MAR) associated with metastatic melanoma which was thought to be in remission for 6 years. Identification of MAR led to the discovery of recurrent malignancy.

Method: A man in his 60s presented with monocular visual disturbances with a large relative afferent pupillary defect, rapidly progressing visual field defect and otherwise normal eye examination. Initial work-up for retrobulbar optic neuropathy was inconclusive. After a few months, similar symptoms developed in his fellow eye and a full-field electroretinogram revealed a reduced b:a wave ratio suspicious for MAR.

Results: Visual field defects were present in both eyes at initial examination, but the visual field of one eye progressed rapidly while the fellow eye did not develop symptoms or progress until roughly 3 months later. Visual field defects and symptoms improved following resection of the lymph node with active metastatic disease and serum plasmapheresis.

Conclusion: This report highlights a case of MAR with asymmetric objective findings and progression of visual field defects. It also demonstrates the success of plasmapheresis, in combination with treating recurrent metastatic disease, in improving visual function.