PDF(Pubmed)
Abstract：
UNASSIGNED: To describe a case of bilateral retinal pigmentary changes in the setting of immune checkpoint inhibitor therapy (ICIT).
UNASSIGNED: A 69-year-old man with a history of advanced cutaneous melanoma was started on combination ICIT with nivolumab and ipilimumab and stereotactic body radiation therapy. Soon after, he developed photopsias and nyctalopia with findings of discrete retinal pigmentary changes bilaterally. Initial visual acuities were 20/20 and 20/30 in the right and left eye, respectively. Multi-modal imaging revealed sub-retinal deposits with progressive changes in pigmentation and autofluorescence, associated with decreased peripheral fields on formal perimetry. A full-field electroretinogram revealed attenuated and delayed a- and b-waves. Positive serum retinal autoantibodies were identified. The patient developed left-sided optic nerve edema and center-involving cystoid macular edema which improved after treatment with sub-tenon\'s triamcinolone.
UNASSIGNED: The use of ICIT has greatly expanded in oncologic practice with subsequent increases in immune related adverse events that pose significant systemic and ophthalmologic morbidities. We propose that the new retinal pigmentary changes seen in this case are the sequelae of an autoimmune inflammatory response against pigmented cells. This adds to the rare side effects that may occur after ICIT.
UNASSIGNED: A 69-year-old man with a history of advanced cutaneous melanoma was started on combination ICIT with nivolumab and ipilimumab and stereotactic body radiation therapy. Soon after, he developed photopsias and nyctalopia with findings of discrete retinal pigmentary changes bilaterally. Initial visual acuities were 20/20 and 20/30 in the right and left eye, respectively. Multi-modal imaging revealed sub-retinal deposits with progressive changes in pigmentation and autofluorescence, associated with decreased peripheral fields on formal perimetry. A full-field electroretinogram revealed attenuated and delayed a- and b-waves. Positive serum retinal autoantibodies were identified. The patient developed left-sided optic nerve edema and center-involving cystoid macular edema which improved after treatment with sub-tenon\'s triamcinolone.
UNASSIGNED: The use of ICIT has greatly expanded in oncologic practice with subsequent increases in immune related adverse events that pose significant systemic and ophthalmologic morbidities. We propose that the new retinal pigmentary changes seen in this case are the sequelae of an autoimmune inflammatory response against pigmented cells. This adds to the rare side effects that may occur after ICIT.
摘要：
■描述在免疫检查点抑制剂治疗（ICIT）的背景下双侧视网膜色素变化的情况。
■一名有晚期皮肤黑色素瘤病史的69岁男子开始接受ICIT联合纳武单抗和伊匹单抗以及立体定向全身放疗。不久之后,他发展了光视和夜视，发现双侧离散的视网膜色素变化。右眼和左眼的初始视力分别为20/20和20/30，分别。多模式成像显示视网膜下沉积有色素沉着和自发荧光的进行性变化，与正式视野减少有关。全场视网膜电图显示衰减和延迟的a波和b波。血清视网膜自身抗体阳性。患者出现左侧视神经水肿和中央累及囊样黄斑水肿，经tenon下曲安奈德治疗后好转。
■ICIT在肿瘤学实践中的应用已大大扩展，随后免疫相关的不良事件增加，这些不良事件会引起明显的全身和眼科疾病。我们认为，在这种情况下看到的新的视网膜色素变化是针对色素细胞的自身免疫性炎症反应的后遗症。这增加了ICIT后可能出现的罕见副作用。
■一名有晚期皮肤黑色素瘤病史的69岁男子开始接受ICIT联合纳武单抗和伊匹单抗以及立体定向全身放疗。不久之后,他发展了光视和夜视，发现双侧离散的视网膜色素变化。右眼和左眼的初始视力分别为20/20和20/30，分别。多模式成像显示视网膜下沉积有色素沉着和自发荧光的进行性变化，与正式视野减少有关。全场视网膜电图显示衰减和延迟的a波和b波。血清视网膜自身抗体阳性。患者出现左侧视神经水肿和中央累及囊样黄斑水肿，经tenon下曲安奈德治疗后好转。
■ICIT在肿瘤学实践中的应用已大大扩展，随后免疫相关的不良事件增加，这些不良事件会引起明显的全身和眼科疾病。我们认为，在这种情况下看到的新的视网膜色素变化是针对色素细胞的自身免疫性炎症反应的后遗症。这增加了ICIT后可能出现的罕见副作用。
