Maidstone & Tunbridge Wells Hospitals NHS Trust, London, UK.
J Immunother. 2020 Nov/Dec;43(9):283-285. doi: 10.1097/CJI.0000000000000328.
Here, we report the presentation and management of a rare case of sight-threatening bilateral panuveitis with secondary chronic hypotony, subcapsular cataracts, exudative retinal detachments, and choroidal detachments, following initiation of pembrolizumab immunotherapy for metastatic melanoma. An 82-year-old white woman presented with painful, blurry vision 3 days after initiation of pembrolizumab immunotherapy. She had developed a marked panuveitis causing secondary hypotony. The fundal view was entirely limited by acutely dense cataracts and small, uveitic pupils unresponsive to topical dilation. Urgent cataract surgery with intravitreal dexamethasone implant (Ozurdex) was completed successfully and allowed a fundal examination. This revealed bilateral, symmetrical, inferior exudative retinal detachments, and choroidal detachments secondary to chronic hypotony. After 3 months of observation and cessation of oral steroids, the panuveitis remains quiescent, hypotony persists, and the choroidal and retinal detachments are showing progressive self-resolution. The current best-corrected visual acuity is 6/24 OU. She remains under close monitoring. The immune checkpoint inhibitor, pembrolizumab, has been reported to cause sight-threatening adverse effects. We report a rare case of profound bilateral complications treated successfully with oral and intravitreal steroids. To the authors' knowledge, this has not previously been reported in the literature. Ophthalmologists and oncologists should be aware of the ocular effects of pembrolizumab and be able to identify various complications early. Here, cataract surgery with a steroid implant has been an effective sight-saving intervention. The promising visual outcome makes this an unusual success story.
在这里，我们报告了一例罕见的病例，该病例在开始使用 pembrolizumab 免疫疗法治疗转移性黑色素瘤后，出现了威胁视力的双侧全葡萄膜炎，伴有继发性慢性低眼压、囊下白内障、渗出性视网膜脱离和脉络膜脱离。
一位 82 岁的白人女性在开始 pembrolizumab 免疫治疗后 3 天出现视力模糊伴疼痛。她发生了明显的全葡萄膜炎，导致继发性低眼压。眼底完全被急性致密白内障和小而对局部扩瞳无反应的葡萄膜炎性瞳孔所限制。紧急白内障手术联合玻璃体内地塞米松植入（Ozurdex）成功完成，并进行了眼底检查。结果显示双侧对称的下象限渗出性视网膜脱离和脉络膜脱离，继发于慢性低眼压。观察 3 个月并停用口服类固醇后，全葡萄膜炎仍处于静止状态，眼压持续低，脉络膜和视网膜脱离正在逐渐自行缓解。目前最佳矫正视力为 6/24OU。她仍在密切监测中。
免疫检查点抑制剂 pembrolizumab 已被报道可引起威胁视力的不良反应。我们报告了一例罕见的严重双侧并发症病例，经口服和玻璃体内类固醇治疗后成功治愈。据作者所知，这在文献中尚未有报道。眼科医生和肿瘤医生应该意识到 pembrolizumab 的眼部影响，并能够早期识别各种并发症。在这里，白内障手术联合类固醇植入已成为一种有效的挽救视力的干预措施。这一令人鼓舞的视力结果使这成为一个不寻常的成功案例。
