Improvement in visual fields in a patient with melanoma-associated retinopathy treated with intravenous immunoglobulin

Melanoma-associated retinopathy (MAR) is a rare disorder characterized by photopsias, shimmering vision, nyctalopia, and dysfunction of rod photoreceptor cells. We describe a 56-year-old man with metastatic cutaneous melanoma to the lymph nodes and MAR. He underwent resection of the metastasis followed by radiation therapy. Over the ensuing 2 months, visual function worsened so he was treated with intravenous immunoglobulin (IVIg). Visual fields, but not electroretinography, improved steadily over the next year. No evidence of recurrence or metastatic disease has been found. Our patient indicates that even after a reduction or elimination of melanoma tumor burden and presumably the attenuation of the antigenic stimulus driving MAR, this disorder can continue to progress. In this setting, IVIg therapy should be considered a viable treatment option.