PDF(Pubmed)
Abstract：
UNASSIGNED: Given the recent additions of immune checkpoint inhibitors (ICIs) to various cancer treatments, adverse effects, especially involving the eyes, have been on the rise. Here, we report an acute exacerbation of cancer-associated retinopathy (CAR) triggered by durvalumab treatment of small-cell lung cancer (SCLC).
UNASSIGNED: An 81-year-old Asian male complained of a scotoma in the left eye after durvalumab administration, to treat SCLC. Humphrey visual field examination revealed a C-shaped temporal scotoma. Spectralis domain optical coherence tomography revealed outer retinal layer atrophy and progressive loss of the ellipsoid zone in the atrophic peripapillary area. Fundus autofluorescence (AF) images evidenced a large C-shaped hypo-AF with enhanced AF at the margin of the atrophic area, thus at the position of the scotoma. We prescribed subtenon triamcinolone injections under suspicion of CAR exacerbation, supported by positive Western blotting results for Rab6 and aldolase, and immunohistochemical staining of photoreceptor cells. The disrupted ellipsoid zone evident on OCT partially recovered, and a visual field test showed that the scotoma had improved.
UNASSIGNED: ICI-triggered exacerbation of CAR should be considered in SCLC patients before ICI treatment commences; an optimal treatment should preserve functional vision.
UNASSIGNED: An 81-year-old Asian male complained of a scotoma in the left eye after durvalumab administration, to treat SCLC. Humphrey visual field examination revealed a C-shaped temporal scotoma. Spectralis domain optical coherence tomography revealed outer retinal layer atrophy and progressive loss of the ellipsoid zone in the atrophic peripapillary area. Fundus autofluorescence (AF) images evidenced a large C-shaped hypo-AF with enhanced AF at the margin of the atrophic area, thus at the position of the scotoma. We prescribed subtenon triamcinolone injections under suspicion of CAR exacerbation, supported by positive Western blotting results for Rab6 and aldolase, and immunohistochemical staining of photoreceptor cells. The disrupted ellipsoid zone evident on OCT partially recovered, and a visual field test showed that the scotoma had improved.
UNASSIGNED: ICI-triggered exacerbation of CAR should be considered in SCLC patients before ICI treatment commences; an optimal treatment should preserve functional vision.
摘要：
■鉴于最近在各种癌症治疗中增加了免疫检查点抑制剂（ICI），不利影响，尤其是涉及眼睛，一直在上升。这里,我们报道了durvalumab治疗小细胞肺癌(SCLC)引发的癌症相关性视网膜病变(CAR)急性加重.
■一名81岁的亚洲男性在服用durvalumab后抱怨左眼暗点，治疗SCLC。Humphrey视野检查显示C形颞叶暗点。谱域光学相干断层扫描显示视网膜外层萎缩，萎缩性乳头周围区域的椭球区逐渐消失。眼底自发荧光（AF）图像证明了一个大的C形hypo-AF与增强的AF在萎缩区域的边缘。因此在暗点的位置。我们在怀疑CAR恶化的情况下开出了subtenon曲安奈德注射液，Rab6和醛缩酶的阳性蛋白质印迹结果支持，和感光细胞的免疫组织化学染色。OCT上明显的被破坏的椭圆体区部分恢复,视野测试表明暗点有所改善。
■在ICI治疗开始前，SCLC患者应考虑ICI引发的CAR加重；最佳治疗应保持功能性视力。
■一名81岁的亚洲男性在服用durvalumab后抱怨左眼暗点，治疗SCLC。Humphrey视野检查显示C形颞叶暗点。谱域光学相干断层扫描显示视网膜外层萎缩，萎缩性乳头周围区域的椭球区逐渐消失。眼底自发荧光（AF）图像证明了一个大的C形hypo-AF与增强的AF在萎缩区域的边缘。因此在暗点的位置。我们在怀疑CAR恶化的情况下开出了subtenon曲安奈德注射液，Rab6和醛缩酶的阳性蛋白质印迹结果支持，和感光细胞的免疫组织化学染色。OCT上明显的被破坏的椭圆体区部分恢复,视野测试表明暗点有所改善。
■在ICI治疗开始前，SCLC患者应考虑ICI引发的CAR加重；最佳治疗应保持功能性视力。
