Kase Satoru, Yamashita Yui, Takeuchi Satoshi, Ishida Susumu
Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
Department of Medical Oncology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
Front Oncol. 2025 May 15;15:1492011. doi: 10.3389/fonc.2025.1492011. eCollection 2025.
It remains unknown whether choroidal circulation could be altered at the onset of immune checkpoint inhibitor (ICI) uveitis compared with that before ICI treatment. Herein we report a patient with Vogt-Koyanagi-Harada (VKH) disease-like uveitis in the unaffected eye as an immune-related adverse effect (irAE) due to ICIs for metastatic choroidal melanoma who had received enucleation. Moreover, choroidal circulation and choroidal thickness were measured before and after treatment.
A 58-year-old man had a medical history of enucleation in his left eye due to choroidal melanoma 6 years ago. Metastatic lesions in the gastrointestinal tracts and lung were found, and then he received ICIs three times. About 1 month later, he suffered from blurred vision and metamorphopsia in his right eye. Choroidal circulation was evaluated by mean blur rate (MBR), a relative value showing choroidal blood velocity on laser speckle flowgraphy. Central choroidal thickness (CCT) was measured on optical coherence tomography.
Since ophthalmic findings revealed VKH-like uveitis, oral prednisolone of 30 mg was given for 2 weeks, which were then tapered. MBR was reduced and CCT increased at the onset of ICI uveitis compared with its baseline and resolution after corticosteroid treatment.
Choroidal circulation was disrupted, possibly due to ICI-induced autoinflammatory reaction to the choroid, which was managed by corticosteroid treatment. The combination of MBR and CCT could be a useful biomarker for managing the patients with VKH-like uveitis by ICIs.
与免疫检查点抑制剂（ICI）治疗前相比，在ICI葡萄膜炎发作时脉络膜循环是否会发生改变仍不清楚。在此，我们报告一名因转移性脉络膜黑色素瘤接受眼球摘除术的患者，其未受影响的眼睛出现了类伏格特-小柳-原田（VKH）病葡萄膜炎，这是ICI引起的免疫相关不良反应（irAE）。此外，还测量了治疗前后的脉络膜循环和脉络膜厚度。
一名58岁男性6年前因脉络膜黑色素瘤接受了左眼眼球摘除术。发现胃肠道和肺部有转移病灶，随后他接受了3次ICI治疗。大约1个月后，他右眼出现视力模糊和视物变形。通过平均模糊率（MBR）评估脉络膜循环，MBR是激光散斑血流图上显示脉络膜血流速度的相对值。在光学相干断层扫描上测量中心脉络膜厚度（CCT）。
由于眼科检查发现类似VKH的葡萄膜炎，给予30mg口服泼尼松龙治疗2周，然后逐渐减量。与基线相比，ICI葡萄膜炎发作时MBR降低，CCT增加，皮质类固醇治疗后恢复正常。
脉络膜循环受到破坏，可能是由于ICI诱导的对脉络膜的自身炎症反应，皮质类固醇治疗可对此进行控制。MBR和CCT的联合应用可能是管理ICI引起的类似VKH葡萄膜炎患者的有用生物标志物。
