Duong Ryan T, Ambati Naveen R, Peddada Krishi V, Elghawy Omar, Gaughan Elizabeth M, Shildkrot Yevgeniy
University of Virginia School of Medicine, 200 Jeanette Lancaster Way, Charlottesville, VA, 22903, USA.
University of Virginia Department of Ophthalmology 1300 Jefferson Park Ave. Charlottesville, VA, 22903, USA.
Am J Ophthalmol Case Rep. 2022 Jan 31;25:101351. doi: 10.1016/j.ajoc.2022.101351. eCollection 2022 Mar.
To present a rare case of multiple evanescent white dot syndrome (MEWDS)-like presentation associated with immune checkpoint inhibitor therapy for metastatic choroidal melanoma.
A 67-year-old non-myopic Caucasian female presented with bilateral worsening vision, flashes, and floaters after receiving two doses of ipilimumab and nivolumab for metastatic class 2 peripheral choroidal melanoma. Fundus imaging of the right eye revealed hypopigmented, extra-foveal scattered chorioretinal lesions with foveal granularity. Fluorescein angiogram and autofluorescence of the right eye demonstrated corresponding hyperfluorescent and hyperautofluorescent lesions in a wreath-like configuration. Optical coherence tomography of the right eye revealed subretinal fluid. Due to concurrent systemic side effects, checkpoint inhibitor therapy was paused and the patient was started on oral prednisone. At her one month follow up visit, her vision in her right eye returned to baseline and subretinal fluid resolved.
This is the first reported case of a MEWDS-like chorioretinopathy after two cycles of ipilimumab/nivolumab therapy for metastatic choroidal melanoma. As immune checkpoint inhibitor therapy is still an evolving field, more research is needed to characterize ocular side effect profiles of these agents.
报告一例罕见的与转移性脉络膜黑色素瘤免疫检查点抑制剂治疗相关的多发性一过性白点综合征（MEWDS）样表现病例。
一名67岁非近视的白种女性，在接受两剂伊匹单抗和纳武单抗治疗转移性2级周边脉络膜黑色素瘤后，出现双侧视力恶化、闪光和飞蚊症。右眼眼底成像显示色素减退、黄斑外散在的脉络膜视网膜病变及黄斑颗粒状改变。右眼荧光素血管造影和自发荧光显示相应病变呈花环样高荧光和高自发荧光。右眼光学相干断层扫描显示视网膜下液。由于同时出现全身副作用，暂停了检查点抑制剂治疗，并让患者开始口服泼尼松。在她一个月的随访中，右眼视力恢复到基线水平，视网膜下液消退。
这是首次报道在接受两周期伊匹单抗/纳武单抗治疗转移性脉络膜黑色素瘤后出现MEWDS样脉络膜视网膜病变的病例。由于免疫检查点抑制剂治疗仍在不断发展，需要更多研究来明确这些药物的眼部副作用特征。
