Gerard Reid1,2, Paul Lorigan3, Heinrich Heimann4, Marta Hovan2. 1. Department of Ophthalmology, Royal Victoria Hospital , Belfast , Northern Ireland. 2. Department of Ophthalmology, Warrington & Holton Hospitals NHS Foundation Trust, Lovely Lane , Warrington , UK. 3. Department of Medical Oncology, The Christie Clinic , Manchester , UK. 4. Department of Ocular Oncology, The Royal Liverpool University Hospital , Liverpool , UK.
Abstract
Purpose: To describe the presentation and management of severe ocular adverse events following treatment with pembrolizumab for cutaneous metastatic melanoma. Methods: Interventional case report. Results: A 73-year-old Caucasian man receiving pembrolizumab treatment for metastatic melanoma presented with panuveitis and subsequent profound hypotony, choroidal effusions, and optic disk swelling bilaterally. Oral prednisolone controlled intraocular inflammation. However, bilateral hypotony persisted which was managed over a 12-month period with ocular viscoelastic device injections into the anterior chamber of both eyes. There was also phacoemulsification with pars plana vitrectomy (PPV) and silicone oil (SO) tamponade performed on the left eye only. Intraocular pressure (IOP) stabilized (>6 mmHg) with best-corrected visual acuity of 6/60. Conclusion: We report a severe adverse event from pembrolizumab therapy resulting in uveitis and persistent hypotony. Repeat injections of high viscosity OVD achieved an increase in IOP up to 12 months. This technique may be a useful adjuvant or alternative to PPV and SO.
Purpose: To describe the presentation and management of severe ocular adverse events following treatment with pembrolizumab for cutaneous metastatic melanoma. Methods: Interventional case report. Results: A 73-year-old Caucasian man receiving pembrolizumab treatment for metastatic melanoma presented with panuveitis and subsequent profound hypotony, choroidal effusions, and optic disk swelling bilaterally. Oral prednisolone controlled intraocular inflammation. However, bilateral hypotony persisted which was managed over a 12-month period with ocular viscoelastic device injections into the anterior chamber of both eyes. There was also phacoemulsification with pars plana vitrectomy (PPV) and silicone oil (SO) tamponade performed on the left eye only. Intraocular pressure (IOP) stabilized (>6 mmHg) with best-corrected visual acuity of 6/60. Conclusion: We report a severe adverse event from pembrolizumab therapy resulting in uveitis and persistent hypotony. Repeat injections of high viscosity OVD achieved an increase in IOP up to 12 months. This technique may be a useful adjuvant or alternative to PPV and SO.
Authors: Michel M Sun; Ralph D Levinson; Artur Filipowicz; Stephen Anesi; Henry J Kaplan; Wei Wang; Debra A Goldstein; Sapna Gangaputra; Robert T Swan; H Nida Sen; Lynn K Gordon Journal: Ocul Immunol Inflamm Date: 2019-03-01 Impact factor: 3.070
Authors: Julia Canestraro; Anna Do; Seth D Potash; Joseph Panarelli; Meghan Berkenstock; David H Abramson; Jasmine H Francis Journal: Am J Ophthalmol Case Rep Date: 2021-05-24