一例与帕博利珠单抗相关的黑色素瘤相关性视网膜病变、葡萄膜炎和视神经炎，采用局部、玻璃体内和静脉内类固醇治疗。
A Case of Melanoma-Associated Retinopathy, Uveitis, and Optic Neuritis Associated With Pembrolizumab, Managed With Topical, Intravitreal, and Intravenous Steroids.
作者信息
Xie Kate, Kong Christina, Mehta Mitul C
机构信息
Department of Ophthalmology, Gavin Herbert Eye Institute, University of California-Irvine, Irvine, CA, USA.
School of Medicine, University of California-Irvine, Irvine, CA, USA.
出版信息
J Vitreoretin Dis. 2019 Nov 14;4(3):220-226. doi: 10.1177/2474126419886154. eCollection 2020 Jun.
PURPOSE
We report a case of advanced metastatic cutaneous melanoma with melanoma-associated retinopathy and pembrolizumab-related panuveitis and optic neuritis.
METHODS
The patient's condition was managed by systemic, topical, and intravitreal corticosteroids without discontinuing pembrolizumab.
RESULTS
After initiation of systemic and topical steroid treatment, optic nerve edema improved. He developed chronic uveitis with cystoid macular edema with improvement in symptoms with intravitreal dexamethasone implants. The patient demonstrated a decrease in all metastatic lesions and improvement in melanoma-associated retinopathy.
CONCLUSIONS
The new checkpoint inhibitor class including pembrolizumab shows promise as a therapy for advanced metastatic melanoma in patients resistant to all other forms of chemotherapy. In general, immune-related adverse effects are responsive to steroid therapy. The trend for treatment of posterior uveitis due to pembrolizumab is to discontinue pembrolizumab. Our case suggests that even severe cases of uveitis may be sufficiently ameliorated by concurrent systemic, intravitreal, and topical therapy to allow continuation of treatment.
目的
我们报告一例晚期转移性皮肤黑色素瘤患者，伴有黑色素瘤相关性视网膜病变以及与帕博利珠单抗相关的全葡萄膜炎和视神经炎。
方法
在不停用帕博利珠单抗的情况下，通过全身、局部和玻璃体内注射皮质类固醇对患者的病情进行处理。
结果
开始全身和局部类固醇治疗后，视神经水肿有所改善。他出现了伴有黄斑囊样水肿的慢性葡萄膜炎，玻璃体内植入地塞米松后症状有所改善。患者所有转移性病灶均减少，黑色素瘤相关性视网膜病变也有所改善。
结论
包括帕博利珠单抗在内的新型检查点抑制剂类药物显示出有望成为对所有其他形式化疗均耐药的晚期转移性黑色素瘤患者的一种治疗方法。一般来说，免疫相关不良反应对类固醇治疗有反应。因帕博利珠单抗导致的后葡萄膜炎的治疗趋势是停用帕博利珠单抗。我们的病例表明，即使是严重的葡萄膜炎病例，通过同时进行全身、玻璃体内和局部治疗也可能得到充分改善，从而能够继续进行治疗。
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