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Case Reports
. 2019 Nov 14;4(3):220-226.
doi: 10.1177/2474126419886154. eCollection 2020 Jun.

A Case of Melanoma-Associated Retinopathy, Uveitis, and Optic Neuritis Associated With Pembrolizumab, Managed With Topical, Intravitreal, and Intravenous Steroids

Kate Xie  1 , Christina Kong  2 , Mitul C Mehta  1
Affiliations
Case Reports

A Case of Melanoma-Associated Retinopathy, Uveitis, and Optic Neuritis Associated With Pembrolizumab, Managed With Topical, Intravitreal, and Intravenous Steroids

Kate Xie et al. J Vitreoretin Dis. .

Abstract

Purpose: We report a case of advanced metastatic cutaneous melanoma with melanoma-associated retinopathy and pembrolizumab-related panuveitis and optic neuritis.

Methods: The patient's condition was managed by systemic, topical, and intravitreal corticosteroids without discontinuing pembrolizumab.

Results: After initiation of systemic and topical steroid treatment, optic nerve edema improved. He developed chronic uveitis with cystoid macular edema with improvement in symptoms with intravitreal dexamethasone implants. The patient demonstrated a decrease in all metastatic lesions and improvement in melanoma-associated retinopathy.

Conclusions: The new checkpoint inhibitor class including pembrolizumab shows promise as a therapy for advanced metastatic melanoma in patients resistant to all other forms of chemotherapy. In general, immune-related adverse effects are responsive to steroid therapy. The trend for treatment of posterior uveitis due to pembrolizumab is to discontinue pembrolizumab. Our case suggests that even severe cases of uveitis may be sufficiently ameliorated by concurrent systemic, intravitreal, and topical therapy to allow continuation of treatment.

Keywords: immunotherapy; melanoma-associated retinopathy; optic neuritis; panuveitis; pembrolizumab; posterior uveitis.

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Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Fundus autofluorescence photos of right and left eyes. (A) At time of presentation, a patchy parafoveal hypofluorescent ring is present in both eyes. There is vitritis in both eyes, left greater than right, responsible for the media opacity. Optic nerve edema is visible in the right eye. (B) Twelve months after presentation, repeat photos show improvement in vitritis, resolution of optic nerve edema, and persistent patchy parafoveal hypofluorescence in both eyes.
Figure 2.
Figure 2.
Serial Humphrey visual field examinations showing some improvement in peripheral vision of both eyes. *Note that Humphrey visual field examination at 4 months was a 24-2 examination, whereas all others were 30-2. FL indicates fixation loss; FN, false negative; FP, false positive; MD, mean deviation.
Figure 3.
Figure 3.
Electroretinogram (ERG) at initial presentation showing depressed rod and cone responses. LE indicates left eye; RE, right eye.
Figure 4.
Figure 4.
A timeline demonstrating the periodicity of steroid therapy and visual changes during this time. CME indicates cystoid macular edema; D/C, discontinues; Dx, diagnosis; OCTm, optical coherence tomography of the macula.
Figure 5.
Figure 5.
Electroretinogram (ERG) at 1 year showing improvement in cone response and unchanged depression of rod response. LE indicates left eye; RE, right eye.
Figure 6.
Figure 6.
Serial optical coherence tomography (OCT) macula studies over time. (A) First OCT macula images obtained for this patient 2 months after initial presentation. (B) Significant worsening of cystoid macular edema and epiretinal membranes in both eyes at 9 months. The patient declined membrane peeling surgery at this time because of poor overall condition. (C) OCT macula images at 14 months, after bilateral intravitreal dexamethasone implants.
See this image and copyright information in PMC

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References

    1. Lu Y, Jia L, He S, et al. Melanoma-associated retinopathy: a paraneoplastic autoimmune complication. Arch Ophthalmol. 2009;127(12):1572–1580. doi:10.1001/archophthalmol.2009.311 - PMC - PubMed
    1. Martin-Liberal J, Kordbacheh T, Larkin J. Safety of pembrolizumab for the treatment of melanoma. Expert Opin Drug Saf. 2015;14(6):957–964. doi:10.1517/14740338.2015.1021774 - PubMed
    1. Antoun J, Titah C, Cochereau I. Ocular and orbital side-effects of checkpoint inhibitors. Curr Opin Oncol. 2016;28(4):288–294. doi:10.1097/CCO.0000000000000296 - PubMed
    1. Manusow JS, Khoja L, Pesin N, Joshua AM, Mandelcorn ED. Retinal vasculitis and ocular vitreous metastasis following complete response to PD-1 inhibition in a patient with metastatic cutaneous melanoma. J Immunother Cancer. 2014;2(1):41. doi:10.1186/s40425-014-0041-1 - PMC - PubMed
    1. Aaberg MT, Aaberg TM, Jr. Pembrolizumab administration associated with posterior uveitis. Retin Cases Brief Rep. 2017;11(4):348–351. doi:10.1097/ICB.0000000000000368 - PubMed

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