Venkat Arthi, Binkley Elaine M, Srivastava Sunil, Karthik Naveen, Singh Arun D
Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Ocul Oncol Pathol. 2021 Mar;7(1):62-65. doi: 10.1159/000511187. Epub 2020 Nov 3.
To describe 2 cases of vitreoretinal metastases in patients treated with immunotherapy for metastatic melanoma.
Retrospective case series.
We pre-sent 2 patients with metastatic melanoma treated with systemic immunotherapy with subsequent development of ocular vitreoretinal metastasis. The first patient was a male with metastatic melanoma from a site of unknown origin that was in complete remission following a course of ipilimumab and nivolumab therapy. He presented to an outside provider for evaluation of vitritis and a pigmented lesion in the right eye that was presumed secondary to toxoplasmosis. After failing initial management with oral antibiotics, he underwent diagnostic pars plana vitrectomy, and vitreous biopsy was consistent with metastatic melanoma to the vitreous. He was additionally found to have an elevated pigmented retinal mass consistent with a retinal metastasis from melanoma that initially failed treatment with plaque brachytherapy and ultimately required enucleation. The second case was a monocular male with metastatic melanoma from cutaneous melanoma with decreased vision 3 months after the initiation of nivolumab therapy. He presented with dense vitreous debris in his seeing eye and was thought to have nivolumab-associated inflammation. He was initially treated with difluprednate with improved vision and decrease in vitreous debris, but developed dense pigment deposition in the affected eye later in the treatment course. Diagnostic pars plana vitrectomy was performed, and vitreous biopsy was positive for malignant melanoma cells. His systemic disease was in remission at the time of diagnosis of ocular metastasis. External beam radiation was recommended given his monocular status.
Vitreoretinal metastasis can develop despite favorable systemic response to immunotherapy in patients with metastatic cutaneous melanoma. Lack of ocular penetration and extension of life span with immunotherapeutic agents may be the underlying mechanism for vitreoretinal metastasis.
描述2例接受免疫治疗的转移性黑色素瘤患者发生玻璃体视网膜转移的情况。
回顾性病例系列研究。
我们报告2例接受全身免疫治疗的转移性黑色素瘤患者，随后发生了眼部玻璃体视网膜转移。首例患者为男性，转移性黑色素瘤原发部位不明，在接受一疗程的伊匹单抗和纳武单抗治疗后完全缓解。他因右眼葡萄膜炎和色素性病变就诊于外院，最初推测为弓形虫病继发。口服抗生素初始治疗失败后，他接受了诊断性玻璃体切割术，玻璃体活检结果与玻璃体转移性黑色素瘤相符。此外，他还被发现有一个色素性视网膜肿物，与黑色素瘤视网膜转移相符，该肿物最初接受敷贴近距离放疗失败，最终需要眼球摘除。第二例患者为单眼男性，皮肤黑色素瘤转移，在开始纳武单抗治疗3个月后视力下降。他患眼出现致密的玻璃体混浊，最初被认为是纳武单抗相关炎症。他最初接受地氟泼尼龙治疗后视力改善，玻璃体混浊减轻，但在治疗过程后期患眼出现致密的色素沉着。进行了诊断性玻璃体切割术，玻璃体活检显示恶性黑色素瘤细胞阳性。在诊断眼部转移时，他的全身疾病处于缓解状态。鉴于他单眼患病，建议进行外照射放疗。
转移性皮肤黑色素瘤患者尽管对免疫治疗有良好的全身反应，但仍可能发生玻璃体视网膜转移。免疫治疗药物缺乏眼内穿透性和延长生存期可能是玻璃体视网膜转移的潜在机制。
