Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing, China.
Department of Ophthalmology, Beijing Puren Hospital, Beijing, China.
Eur J Ophthalmol. 2024 May;34(3):NP29-NP33. doi: 10.1177/11206721231222659. Epub 2024 Jan 5.
Ocular immune-related adverse events (OirAEs) associated with novel cancer therapies of immune checkpoint inhibitors (ICIs) are emerging. Retrobulbar optic neuritis (ON) combined with optic perineuritis (OPN), associated with atezolizumab, has been rarely reported and has a unique clinical manifestation.
A 67-year-old woman was diagnosed with small-cell lung cancer. As maintenance therapy, atezolizumab was administered continuously for 10 cycles for approximately 14 months. One week after the administration of the tenth dose of atezolizumab, the patient experienced a bilateral, successive painless visual decline. The fundus and the retinal nerve fiber layer revealed no abnormalities, but the ganglion cell of the macula disappeared loss. The concentric shrinking of the peripheral visual field of the left eye was noticed. Orbital MRI revealed bilateral optic nerve thickening and peripheral optic nerve sheath enhancement ("tram-track" and "doughnut" signs). Serology, cerebrospinal fluid results, and image examination ruled out common causes of vision decline, and the condition was identified as bilateral retrobulbar ON combined with OPN as a probable atezolizumab-related immune adverse event. Thereafter, atezolizumab was discontinued, and intravenous methylprednisolone pulse (IVMP) (160 mg/day for 5 days) plus intravenous immunoglobulin (20 g/day for 3 days) was administered. The patient's visual function considerably improved after three weeks.
Retrobulbar ON and OPN associated with atezolizumab are rare side effects that are easily overlooked. Immune-related ON has unique features and requires early identification. The primary treatment for optic nerve irAEs is corticosteroids, but this is not standardized and should be used with caution.
新型癌症治疗药物免疫检查点抑制剂（ICI）相关的眼部免疫相关不良反应（OirAEs）正在不断出现。与阿替利珠单抗相关的球后视神经炎（ON）合并视神经周围炎（OPN）较为罕见，具有独特的临床表现。
一名 67 岁女性被诊断为小细胞肺癌。阿替利珠单抗作为维持治疗，连续给药 10 个周期，约 14 个月。阿替利珠单抗第十次给药后一周，患者出现双侧、相继无痛性视力下降。眼底和视网膜神经纤维层未见异常，但黄斑部神经节细胞消失。左眼周边视野呈向心性缩小。眼眶 MRI 显示双侧视神经增粗，视神经鞘周围增强（“轨道征”和“甜甜圈征”）。血清学、脑脊液结果和影像学检查排除了常见的视力下降原因，该患者被诊断为双侧球后视神经炎合并视神经周围炎，可能与阿替利珠单抗相关的免疫不良反应有关。此后，停用阿替利珠单抗，给予静脉注射甲基泼尼松龙脉冲（IVMP）（160mg/天，连用 5 天）联合静脉注射免疫球蛋白（20g/天，连用 3 天）。三周后，患者的视力功能显著改善。
与阿替利珠单抗相关的球后视神经炎和视神经周围炎是罕见的副作用，容易被忽视。免疫相关性 ON 具有独特的特征，需要早期识别。视神经免疫相关不良反应的主要治疗方法是皮质类固醇，但尚未标准化，应谨慎使用。
