Department of Ophthalmology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
Doc Ophthalmol. 2021 Jun;142(3):353-360. doi: 10.1007/s10633-020-09800-0. Epub 2021 Jan 4.
The study reports a case with metastatic cutaneous malignant melanoma that developed Vogt-Koyanagi-Harada-like uveitis during pembrolizumab treatment. The uveitis improved by discontinuation of pembrolizumab and use of oral and topical steroids. Full-field flicker ERGs were used to monitor the retinal function before and after the steroid treatments.
A 68-year-old women presented with blurred vision in both eyes 3 months after beginning pembrolizumab adjuvant therapy for a malignant melanoma on the lower thigh. Optical coherence tomography showed a serous retinal detachment (SRD) in the right eye and marked choroidal thickening in both eyes. Fluorescein angiography showed spotted hyperfluorescence in the right eye and leakage of fluorescein from both optic disks. Indocyanine green angiography showed dark hypofluorescent spots in both eyes. She was diagnosed with Vogt-Koyanagi-Harada-like uveitis induced by pembrolizumab and discontinued the pembrolizumab. She was then treated with oral prednisolone and topical betamethasone. One week later, the symptoms were improved, and 1 month later the choroidal thickening in both eyes and the SRD of the right eye were not present. The implicit time of the full-field flicker ERGs recorded by RETeval system was significantly delayed at the initial examination but improved within a few weeks after the steroid replacement treatment.
Our case with Vogt-Koyanagi-Harada-like uveitis induced by pembrolizumab had a reduction in the degree of uveitis after discontinuation of the pembrolizumab and use of oral prednisolone and topical betamethasone. Flicker ERGs were helpful in monitoring the retinal function before and after the steroid treatment.
本研究报告了一例转移性皮肤恶性黑色素瘤患者，在接受 pembrolizumab 治疗期间发生 Vogt-Koyanagi-Harada 样葡萄膜炎。葡萄膜炎通过停用 pembrolizumab 及使用口服和局部皮质类固醇而改善。使用全视野闪烁 ERG 在皮质类固醇治疗前后监测视网膜功能。
一名 68 岁女性，在开始使用 pembrolizumab 辅助治疗大腿下部恶性黑色素瘤 3 个月后出现双眼视力模糊。光学相干断层扫描显示右眼浆液性视网膜脱离（SRD），双眼脉络膜明显增厚。荧光素血管造影显示右眼点状高荧光，双视盘荧光素渗漏。吲哚青绿血管造影显示双眼暗低荧光点。诊断为 pembrolizumab 诱导的 Vogt-Koyanagi-Harada 样葡萄膜炎，并停用 pembrolizumab。然后给予口服泼尼松龙和局部倍他米松治疗。1 周后症状改善，1 个月后双眼脉络膜增厚及右眼 SRD 消失。RETeval 系统记录的全视野闪烁 ERG 的潜伏时间在初始检查时明显延迟，但在皮质类固醇替代治疗后数周内得到改善。
我们的 pembrolizumab 诱导的 Vogt-Koyanagi-Harada 样葡萄膜炎病例，在停用 pembrolizumab 和使用口服泼尼松龙及局部倍他米松后，葡萄膜炎的严重程度有所减轻。闪烁 ERG 有助于监测皮质类固醇治疗前后的视网膜功能。
