A Case Of Ipilimumab-Induced Unusual Serous Retinal Detachment In Bilateral Eyes
A Case Of Ipilimumab-Induced Unusual Serous Retinal Detachment In Bilateral Eyes
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DOI：
10.2147/imcrj.s225173
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发表时间：
2019-01-01
影响因子：
0.9
通讯作者：
Akiyama, Hideo
中科院分区：
文献类型：
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作者：
Miyakubo, Tomoko;Mukai, Ryo;Akiyama, Hideo
目的：Ipilimumab是一种免疫检查点抑制剂，目前广泛用于转移性恶性黑色素瘤患者。然而，这种免疫检查点抑制剂可在各种器官中诱导相关不良事件。在这里，我们报告了一例双侧药物（ipilimumab）诱导的浆液性视网膜脱离（SRD），以及扫描源光学相干断层扫描（SS-OCT）过程中发现的特征性特征。病例：一名78岁的转移性黑色素瘤男性患者从2014年1月开始接受4个周期的达卡巴嗪、尼莫司汀、长春新碱和干扰素-β，随后从2014年9月开始接受47个周期的纳武单抗。2017年6月开始接受伊匹单抗治疗。在2个周期的易普利姆玛治疗后，患者注意到双眼视野受损（第22天），并于2017年8月来我科就诊。初次访视时，双眼的最佳矫正视力为16/20，而眼底检查显示双眼均存在SRD和视网膜色素上皮细胞脱离。当使用SS-OCT的水平和垂直12 mm B扫描图像时，我们检测到SRD伴随着感光细胞外节的广泛分布的高反射，包括SRD出现的区域。此外，图像还显示交错区难以区分。荧光素血管造影显示黄斑几乎没有渗漏。在他的随访检查过程中，SRD在开始时增加，之后逐渐下降。结论：Ipilimumab可引起视网膜外层损害。我们认为这是一个假定的ipilimumab诱导的SRD。
Purpose: Ipilimumab is an immune checkpoint inhibitor that is now widely used for patients with metastatic malignant melanoma. However, this immune checkpoint inhibitor can induce related adverse events in various organs. Here, we report a case of bilateral drug (ipilimumab)-induced serous retinal detachment (SRD), and the characteristic features found during swept-source optical coherence tomography (SS-OCT).Case: A 78-year-old man with metastatic melanoma received 4 cycles of dacarbazine, nimustine, vincristine, and interferon-beta starting in January 2014, followed by 47 cycles of nivolumab starting in September 2014. Treatment with ipilimumab was started in June 2017. After 2 cycles of ipilimumab, the patient noticed impairment of the visual field in both of his eyes (at day 22) and visited our department in August 2017. Best corrected visual acuity at this initial visit was 16/20 in both eyes, while a fundus examination revealed SRD and retinal pigment epithelial detachments in both eyes. When using the horizontal and vertical 12 mm B-scanned images of SS-OCT, we detected SRD accompanied by a widely distributed high reflection of the photoreceptor outer segment, including the area where the SRD appeared. In addition, the image also showed the interdigitation zone was indistinguishable. Fluorescein angiography showed little leakage in the maculae. During his course of follow-up examinations, there was an increase in the SRD at the beginning, after which it then gradually decreased. However, the obscurity of the interdigitation zone remained.Conclusion: Ipilimumab may cause impairment of the outer retinal layer. We suggest that this is a presumed ipilimumab-induced SRD.