Ocular Complications in a Patient with Metastatic Melanoma Undergoing Immunotherapy
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Yes
Purpose
To report a rare case of bilateral ocular inflammation in a patient receiving immunotherapy for metastatic melanoma, emphasizing diagnostic and management challenges.
Methods
A 60-year-old male with metastatic melanoma undergoing Nivolumab and Ipilimumab treatment presented with progressive bilateral visual decline. The initial ophthalmologic examination revealed whitening of the eyelashes and eyebrows (poliosis), corrected visual acuity of 20/130 in both eyes, signs of bilateral uveitis with 360-degree posterior synechiae, hypotony (4 mmHg), bilateral macular edema and optic neuritis in the left eye. Optical coherence tomography (OCT) of the macula and optic nerve, along with ultrasonography confirmed the findings. Immunotherapy was suspended and the patient received anti-VEGF (ranibizumab) and sub-Tenon triamcinolone injections. Corticosteroids were used systemically to manage immune-related adverse effects.
Results
Following treatment visual acuity improved to 20/60 in the right eye (OD) and 20/80 in the left eye (OS). OCT showed reduced macular edema, though residual subretinal fluid persisted. Optic disc swelling decreased and intraocular pressure normalized (10 mmHg bilaterally). Despite partial improvement, the patient continued to experience chronic inflammation requiring ongoing monitoring.
Conclusion
This case highlights the complexity of managing ocular complications related to immunotherapy, where early detection and a multidisciplinary approach are crucial.
Conflict of interest
No
1
Last name
LEBER
Initials of first name(s)
Mat
Department
Federal University of Santa Maria
City
Rio de Janeiro
Country
Brazil
2
Last name
Milbradt
Initials of first name(s)
Tani
Department
Federal University of Santa Maria
City
Santa Maria
Country
Brazil
3
Last name
Leber
Initials of first name(s)
T
Department
Americas Oftalmocenter
City
Rio de Janeiro
Country
Brazil
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