目的:系统文献综述以前使用的治疗方案对已证实的癌症相关性视网膜病变(CAR)患者的治疗效果。
结论:对于非常差的CAR和视觉预后,没有普遍接受的治疗算法。我们描述了在高剂量皮质类固醇治疗后视力显着改善的CAR患者,然后进行血浆置换(PLEX),并提出了先前使用的方案在治疗已证实的CAR患者中的治疗效果的系统文献综述结果。
方法:我们描述了一名70岁的CAR患者,他在接受高剂量的全身性皮质类固醇治疗后7次PLEX治疗后,视力显着改善。然后,我们报告了所有以前发表的英文文献的系统评价结果,这些文献讨论了用于抗体证实的CAR患者的各种治疗方案的视觉结果。
结果:该指标患者是首例CAR患者,在接受高剂量皮质类固醇和PLEX治疗后视力持续显著改善。系统评价确定了28例抗体证实的CAR病例,其中26个用类固醇治疗,导致不同程度的视力改善58%(15/26)。从症状发作到开始治疗的时间和类固醇的剂量不影响视觉结果。除类固醇外,三名患者还接受了PLEX治疗,2/3的视力得到改善,然而,仅接受类固醇治疗的患者与接受类固醇+PLEX治疗的患者的视觉结局没有差异。
结论:使用类固醇和/或类固醇+PLEX治疗可在60%的患者中改善视力。用PLEX去除抗恢复素抗体可以阻止对光感受器的免疫攻击,并可能改善视觉功能,因此除了类固醇外,还应该考虑它。为了建立治疗方案并进一步确定不同方法的有效性,需要对更大的队列进行进一步的研究。
Systematic literature
review of treatment efficacy of previously used protocols in treating patients with proven cancer-associated retinopathy (CAR).
There is no universally accepted treatment algorithm for CAR and visual prognosis is very poor. We describe a patient with CAR with dramatic improvement in vision after treatment with high doses of corticosteroids followed by plasma exchange (PLEX) and present results of a systematic literature
review of treatment efficacy of previously used protocols in treating patients with proven CAR.
We describe a 70-year-old man with CAR who demonstrated dramatic improvement in vision after treatment with high doses of systemic corticosteroids followed by 7 sessions of PLEX. We then report the results of a systematic
review of all previously published English literature discussing visual outcomes of various treatment regimens used for patients with antibody-proven CAR.
The index patient is a rare case of CAR with sustained significant improvement in vision after treatment with high doses of corticosteroids followed by PLEX. The systematic
review identified 28 antibody-proven cases of CAR, 27 of which were treated with steroids, which resulted in varying degrees of improvement in visual acuity in 59% (16 of 27). The time from symptom onset to initiation of treatment and the dose of steroids did not influence the visual outcome. Three patients were also treated with PLEX in addition to steroids, and 2 of 3 patients demonstrated improvement in vision; however, there was no difference in visual outcome in patients treated with steroids only versus those treated with steroids + PLEX.
Treatment with steroids or steroids + PLEX resulted in some improvements in visual acuity in 59% of patients. Removal of antirecoverin antibodies with PLEX can arrest the immune attack on the photoreceptors and potentially improve visual function; thus, it should be considered in addition to steroids. Further studies with larger cohorts are needed to establish a treatment protocol and further determine the effectiveness of the different approaches.
The author(s) have no proprietary or commercial interest in any materials discussed in this article.