Funagura Naofumi, Fukushima Satoshi, Inoue Toshihiro
Department of Ophthalmology, Faculty of Life Science, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, Japan.
Department of Dermatology and Plastic Surgery, Faculty of Life Science, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, Japan.
Am J Ophthalmol Case Rep. 2023 Jan 20;29:101807. doi: 10.1016/j.ajoc.2023.101807. eCollection 2023 Mar.
Ipilimumab is an immune checkpoint inhibitor that occasionally causes ophthalmic immune-related adverse events (irAEs) such as dry eye, uveitis, and episcleritis. We report a case of ipilimumab-related uveitis and refractory hypotony with a flat anterior chamber (AC) in a trabeculectomized eye with exfoliation glaucoma.
A 69-year-old man with a history of cataract surgery and trabeculectomy for exfoliation glaucoma in the right eye presented with blurred vision at 2 months after initiation of ipilimumab for metastatic malignant melanoma (day 0). Although no ophthalmic irAEs were observed at the first visit, he developed iritis, vitreous opacity, and choroidal detachment by day 18.As a result of the irAEs, the scheduled course of ipilimumab was canceled and he was instead treated with corticosteroids (eye drops and systemic). The symptoms progressed, and on day 32 visual acuity was light perception, with a flat AC, hypotony maculopathy, and severe choroidal detachment in the right eye. The patient received two AC formations with a viscoelastic substance, but the flat AC and hypotony recurred. Because the effects of the surgeries were temporary, high doses of corticosteroids were administered. AC depth, anterior uveitis, intraocular pressure, and choroidal detachment resolved by day 91.
Ophthalmologists and oncologists should be aware of the rare but severe irAEs, and careful follow-up is required for ophthalmic irAEs caused by ipilimumab, especially in cases with a history of glaucoma surgery.
伊匹木单抗是一种免疫检查点抑制剂，偶尔会引起眼部免疫相关不良事件（irAEs），如干眼症、葡萄膜炎和巩膜炎。我们报告了一例在患有剥脱性青光眼且已行小梁切除术的眼中发生的与伊匹木单抗相关的葡萄膜炎和难治性低眼压伴前房扁平的病例。
一名69岁男性，有右眼白内障手术和剥脱性青光眼小梁切除术史，在开始使用伊匹木单抗治疗转移性恶性黑色素瘤（第0天）2个月后出现视力模糊。首次就诊时未观察到眼部irAEs，但在第18天时他出现了虹膜炎、玻璃体混浊和脉络膜脱离。由于这些irAEs，伊匹木单抗的预定疗程被取消，取而代之的是用皮质类固醇（眼药水和全身用药）进行治疗。症状进展，在第32天时右眼视力仅为光感，前房扁平、黄斑部低眼压病变和严重脉络膜脱离。患者接受了两次用粘弹性物质形成前房的手术，但前房扁平及低眼压复发。由于手术效果是暂时的，于是给予了高剂量皮质类固醇。到第91天时，前房深度、前部葡萄膜炎、眼压和脉络膜脱离均得到缓解。
眼科医生和肿瘤学家应意识到这种罕见但严重的irAEs，对于伊匹木单抗引起的眼部irAEs需要进行仔细随访，尤其是在有青光眼手术史的病例中。
