Retrospective report describes rapid vision loss due to cancer-associated retinopathy after CAR T-cell therapy, suggesting new pathophysiology insights.
PURPOSE: To describe a case of cancer-associated retinopathy (CAR) after chimeric antigen receptor T (CART)-cell therapy. METHODS: Retrospective case report. RESULTS: A 71-year-old man with follicular lymphoma refractory to multiple chemotherapies underwent CART-cell therapy. Two weeks after CART initiation, he presented with rapid-onset decreased peripheral vision in both eyes. Fluorescein angiography showed attenuation of peripheral vessel filling, and optical coherence tomography showed loss of ellipsoid zone with foveal sparing. Electroretinography revealed nondetectable rod responses and severely prolonged and diminished cone responses. Antiretinal antibody testing showed positive antienolase and antiheat shock protein 60 antibodies on Western blot with strong staining of the outer segments on immunohistochemistry. The patient was diagnosed with CAR and is currently on monthly IV immunoglobulin (IVIg) with stable central visual acuity. CONCLUSION: This patient developed CAR immediately after receiving CART-cell therapy, which depletes B cells. This suggests that CAR pathophysiology may not be purely autoantibody mediated as typically believed.
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Mann et al. (2026) studied this question.
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