Yu Caberry W, Yau Matthew, Mezey Natalie, Joarder Ishraq, Micieli Jonathan A
Faculty of Medicine, Queen's University, Kingston, Canada.
Faculty of Medicine, University of Toronto, Toronto, Canada.
Eye Brain. 2020 Nov 3;12:139-167. doi: 10.2147/EB.S277760. eCollection 2020.
Immune checkpoint inhibitors (ICIs) are novel cancer therapies that may be associated with immune-related adverse events (IRAEs) and come to the attention of neuro-ophthalmologists. This systematic review aims to synthesize the reported ICI-associated IRAEs relevant to neuro-ophthalmologists to help in the diagnosis and management of these conditions.
A systematic review of the literature indexed by MEDLINE, Embase, CENTRAL, and Web of Science databases was searched from inception to May 2020. Reporting followed the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. Primary studies on ICIs and neuro-ophthalmic complications were included. Outcomes included number of cases and incidence of neuro-ophthalmic IRAEs.
Neuro-ophthalmic complications of ICIs occurred in 0.46% of patients undergoing ICI and may affect the afferent and efferent visual systems. Afferent complications include optic neuritis (12.8%), neuroretinitis (0.9%), and giant cell arteritis (3.7%). Efferent complications include myasthenia gravis (MG) (45.0%), thyroid-like eye disease (11.9%), orbital myositis (13.8%), general myositis with ptosis (7.3%), internuclear ophthalmoplegia (0.9%), opsoclonus-myoclonus-ataxia syndrome (0.9%), and oculomotor nerve palsy (0.9%). Pembrolizumab was the most common causative agent for neuro-ophthalmic complications (32.1%). Mortality was highest for MG (19.8%). Most patients (79.8%) experienced improvement or complete resolution of neuro-ophthalmic symptoms due to cessation of ICI and immunosuppression with systemic corticosteroids.
While incidence of neuro-ophthalmic IRAEs is low, clinicians involved in the care of cancer patients must be aware of their presentation to facilitate prompt recognition and management. Collaboration between oncology and neuro-ophthalmology teams is required to effectively manage patients and reduce morbidity and mortality.
免疫检查点抑制剂（ICIs）是新型癌症治疗药物，可能与免疫相关不良事件（IRAEs）相关，已引起神经眼科医生的关注。本系统评价旨在综合报道的与神经眼科医生相关的ICI相关IRAEs，以帮助诊断和管理这些病症。
对MEDLINE、Embase、CENTRAL和Web of Science数据库索引的文献进行系统评价，检索时间从数据库建立至2020年5月。报告遵循系统评价和Meta分析的首选报告项目（PRISMA）指南。纳入关于ICIs和神经眼科并发症的原始研究。结果包括病例数和神经眼科IRAEs的发生率。
接受ICI治疗的患者中，ICIs的神经眼科并发症发生率为0.46%，可能影响视觉传入和传出系统。传入并发症包括视神经炎（12.8%）、神经视网膜炎（0.9%）和巨细胞动脉炎（3.7%）。传出并发症包括重症肌无力（MG）（45.0%）、甲状腺样眼病（11.9%）、眼眶肌炎（13.8%）、伴有上睑下垂的全身性肌炎（7.3%）、核间性眼肌麻痹（0.9%）、眼阵挛-肌阵挛-共济失调综合征（0.9%）和动眼神经麻痹（0.9%）。帕博利珠单抗是神经眼科并发症最常见的致病药物（32.1%）。MG的死亡率最高（19.8%）。大多数患者（79.8%）因停用ICI和使用全身性皮质类固醇进行免疫抑制，神经眼科症状得到改善或完全缓解。
虽然神经眼科IRAEs的发生率较低，但参与癌症患者护理的临床医生必须了解其表现，以便及时识别和管理。肿瘤学和神经眼科学团队之间需要合作，以有效管理患者并降低发病率和死亡率。
