Sandhu Harpal S, Kolomeyer Anton M, Lau Marisa K, Shields Carol L, Schuchter Lynn M, Nichols Charles W, Aleman Tomas S
Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania.
Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania.
Retin Cases Brief Rep. 2019;13(2):103-107. doi: 10.1097/ICB.0000000000000604.
To describe a patient with BRAF mutation-positive cutaneous melanoma who developed acute exudative polymorphous vitelliform maculopathy during vemurafenib and pembrolizumab treatment for metastatic melanoma.
Retrospective case report documented with wide-field fundus imaging, spectral domain optical coherence tomography, and fundus autofluorescence imaging.
A 55-year-old woman with bilateral ductal breast carcinoma and BRAF mutation-positive metastatic cutaneous melanoma complained of bilateral blurred vision within 5 days of starting vemurafenib (BRAF inhibitor). She had been on pembrolizumab (program death receptor antibody) and intermittently on dabrafenib (BRAF inhibitor) and trametinib (MEK inhibitor), and had a normal ophthalmologic examination. On presentation three weeks after the introduction of vemurafenib, her visual acuity had declined to 20/40 in both eyes. Her examination showed diffuse elevation of the fovea with multifocal yellow-white, crescent-shaped subretinal deposits within the macula of both eyes and bilateral neurosensory retinal detachments by spectral domain optical coherence tomography. Discontinuation of vemurafenib and introduction of difluprednate and dorzolamide led to a gradual resolution (over four months) of the neurosensory detachments with recovery of vision.
This case report suggests that acute exudative polymorphous vitelliform maculopathy may be directly associated with the use of BRAF inhibitors as treatment for metastatic cutaneous melanoma, or indirectly by triggering autoimmune-paraneoplastic processes. Future identification of similar associations is required to unequivocally link vemurafenib and/or pembrolizumab to acute exudative polymorphous vitelliform maculopathy in metastatic melanoma.
描述一名BRAF突变阳性的皮肤黑色素瘤患者，该患者在使用维莫非尼和派姆单抗治疗转移性黑色素瘤期间发生了急性渗出性多形性卵黄样黄斑病变。
回顾性病例报告，记录了广域眼底成像、光谱域光学相干断层扫描和眼底自发荧光成像。
一名55岁患有双侧导管性乳腺癌且BRAF突变阳性的转移性皮肤黑色素瘤女性，在开始使用维莫非尼（BRAF抑制剂）后5天内出现双侧视力模糊。她一直在使用派姆单抗（程序性死亡受体抗体），并间歇性使用达拉非尼（BRAF抑制剂）和曲美替尼（MEK抑制剂），眼科检查正常。在开始使用维莫非尼三周后就诊时，她的双眼视力下降至20/40。检查发现双眼黄斑中心凹弥漫性隆起，黄斑内有多灶性黄白色新月形视网膜下沉积物，光谱域光学相干断层扫描显示双侧神经感觉性视网膜脱离。停用维莫非尼并使用氟米龙和多佐胺后，神经感觉性脱离逐渐消退（历时四个月），视力恢复。
本病例报告表明，急性渗出性多形性卵黄样黄斑病变可能与使用BRAF抑制剂治疗转移性皮肤黑色素瘤直接相关，或通过触发自身免疫性副肿瘤过程间接相关。未来需要进一步确定类似关联，以明确将维莫非尼和/或派姆单抗与转移性黑色素瘤中的急性渗出性多形性卵黄样黄斑病变联系起来。
