Department of Ophthalmology, Kocaeli University Medical Faculty, Kocaeli, Turkey.
Department of Ophthalmology, Acıbadem Mehmet Ali Aydinlar University, Istanbul, Turkey.
Semin Ophthalmol. 2021 Nov 17;36(8):794-799. doi: 10.1080/08820538.2021.1906916. Epub 2021 Mar 29.
Nivolumab is an immune checkpoint inhibitor that has recently been widely used for metastatic malignant melanoma. We report a case who developed multiple different ocular immune-related side effects (iRAEs) related to nivolumab. A 60-year-old man on nivolumab treatment for metastatic malignant melanoma developed a decrease in vision in both eyes several days after the third infusion. The initial best-corrected visual acuity (BCVA) was counting fingers in both eyes. Slit-lamp examination revealed no abnormal findings in the anterior segment of both eyes. Posterior segment evaluation showed serous retinal detachment, including the whole macula and inferior retina in both eyes, and optical coherence tomography (OCT) confirmed the diagnosis. On en face OCT analysis, hyperautoflorescent dots were noticed on the whole macular region but more intense at the inferior quadrant corresponding to serous retinal detachment. On Fluorescein Angiography (FA), no abnormality was observed. Oral corticosteroid treatment was administered. Subretinal fluid resolved one week after treatment in the right eye and two weeks after treatment in the left eye. BCVA was 20/20 in both eyes at first month of treatment. After that, oral corticosteroid treatment was tapered and stopped at the end of the second month. The patient was followed monthly. Two months after the treatment patient presented with an anterior uveitis episode with mild vision loss. Slit-lamp examination revealed 3+ cells in the anterior chamber and posterior synechia in both eyes. Posterior segment examination was normal. The patient was treated with topical corticosteroid and cycloplegic for two months. Hyperautoflorescent dots formed with serous detachment disappeared six months after the onset of serous detachment, and they did not occur during anterior uveitis episodes. This is the first clinical report of nivolumab-associated ocular iRAEs presenting with recurrent episodes presenting with serous retinal detachment and anterior uveitis. En face OCT imaging may help diagnose and show the activity of the posterior segment manifestation. When managed properly and observed closely following general and ocular conditions, it is possible to held iRAEs and overcome them by oral and/or topical corticosteroid therapy without interrupting the nivolumab.
纳武利尤单抗是一种免疫检查点抑制剂，最近已广泛用于转移性恶性黑色素瘤。我们报告了一例与纳武利尤单抗相关的多种不同眼部免疫相关不良反应（iRAE）的病例。一名 60 岁男性，转移性恶性黑色素瘤患者，在接受纳武利尤单抗治疗后第 3 次输注后数天出现双眼视力下降。最初最佳矫正视力（BCVA）在双眼均为指数。裂隙灯检查显示双眼前段均无异常发现。后节评估显示双眼均有浆液性视网膜脱离，累及整个黄斑和下部视网膜，光学相干断层扫描（OCT）证实了这一诊断。在共焦 OCT 分析中，注意到整个黄斑区域有高自发荧光点，但在对应于浆液性视网膜脱离的下象限更强烈。在荧光血管造影（FA）中未发现异常。给予口服皮质类固醇治疗。右眼治疗 1 周后，左眼治疗 2 周后，视网膜下液消退。治疗后第 1 个月双眼 BCVA 均为 20/20。此后，口服皮质类固醇逐渐减量并在第 2 个月末停药。患者每月接受随访。治疗后 2 个月，患者出现前葡萄膜炎发作，视力轻度下降。裂隙灯检查显示双眼前房有 3+细胞和后粘连。后节检查正常。患者接受了 2 个月的局部皮质类固醇和睫状肌麻痹治疗。浆液性脱离后 6 个月，高自发荧光点与浆液性脱离一起形成，在前葡萄膜炎发作时没有出现。这是首例纳武利尤单抗相关眼部 iRAE 表现为复发性浆液性视网膜脱离和前葡萄膜炎的临床报告。共焦 OCT 成像有助于诊断和显示后节表现的活动性。当对全身和眼部情况进行适当管理并密切观察时，可以通过口服和/或局部皮质类固醇治疗来控制 iRAE 并克服它们，而无需中断纳武利尤单抗治疗。
