伊匹木单抗/纳武单抗相关的周边溃疡性角膜炎中的双侧角膜穿孔
Bilateral corneal perforation in Ipilimumab/Nivolumab - associated peripheral ulcerative keratitis.
作者信息
Aschauer Julia, Donner Ruth, Lammer Jan, Schmidinger Gerald
机构信息
Department of Ophthalmology and Optometry, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
出版信息
Am J Ophthalmol Case Rep. 2022 Aug 26;28:101686. doi: 10.1016/j.ajoc.2022.101686. eCollection 2022 Dec.
PURPOSE
To present a case of immune checkpoint inhibitor-induced bilateral peripheral ulcerative keratitis that progressed to corneal perforation requiring keratoplasty in both eyes.
OBSERVATIONS
We describe the course of a 60-year-old man treated with a combination of Ipilimumab and Nivolumab for metastatic melanoma who presented with foreign body sensation and epiphora in both eyes.Bilateral immune-related peripheral ulcerative keratitis was refractory to topical anti-inflammatory therapy, necessitating repetitive, but unsuccessful cyanoacrylate gluing procedure followed by bilateral lamellar mini-keratoplasty.
CONCLUSIONS AND IMPORTANCE
Combined immune checkpoint inhibition revokes the corneal immune privilege and can lead to auto-immune keratitis with recalcitrant progression to ulceration and perforation.
目的
报告1例免疫检查点抑制剂诱发的双侧周边溃疡性角膜炎，病情进展至角膜穿孔，双眼均需进行角膜移植术。
观察结果
我们描述了一名60岁男性的病程，该患者因转移性黑色素瘤接受伊匹木单抗和纳武单抗联合治疗，出现双眼异物感和溢泪。双侧免疫相关性周边溃疡性角膜炎对局部抗炎治疗无效，需要反复进行氰基丙烯酸酯粘贴术，但未成功，随后进行了双眼板层微型角膜移植术。
结论与重要性
联合免疫检查点抑制作用会消除角膜免疫赦免，可导致自身免疫性角膜炎，并顽固地进展为溃疡和穿孔。
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