Purpose

Melanoma-associated retinopathy (MAR) is a rare paraneoplastic syndrome due to antibodies targeting bipolar retinal cells. Its evolution, particularly in patients treated with immune checkpoint inhibitors (ICI), is currently poorly understood. In the few cases published, patients’ visual function got worse when these molecules were prescribed. Here, we present a case of a patient with severe MAR treated with an ICI for melanoma progression.

Methods

A 68-year-old woman with a history of melanoma of the palpebral conjunctiva presented with sudden and gradually worsening visual disturbances. Simultaneously, a metastatic evolution of the melanoma was diagnosed and surgically treated exclusively. Visual acuity assessment, static automated perimetry and ERG results lead to the diagnosis of MAR. Since systemic corticosteroid therapy did not improve her symptoms, repeated intraocular corticosteroid injections were performed with a positive outcome. Later on, metastatic progression of the patient’s melanoma led to the introduction of pembrolizumab, an ICI targeting PD-1. Immunotherapy has changed the prognosis of patient affected by metastatic melanoma, but these molecules may induce various immune-related adverse effects. In our case, intraocular corticosteroid injections were still performed simultaneously. Visual acuity assessment, static automated perimetry and ERG were performed during the course of this treatment.

Results

Full-field ERGs results suggested the possibility that the ophthalmologic treatment might restore the patient’s retinal function despite the continued immunotherapy.

Conclusion

We report the first case of MAR with a positive outcome after 1 year of ICI, possibly thanks to intravitreal corticosteroid therapy.

中文翻译：

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派姆单抗治疗期间黑色素瘤相关视网膜病变可能通过玻璃体内注射地塞米松控制。

目的

黑色素瘤相关视网膜病变 (MAR) 是一种罕见的副肿瘤综合征，这是由于抗体靶向双极视网膜细胞所致。它的演变，特别是在接受免疫检查点抑制剂 (ICI) 治疗的患者中，目前知之甚少。在发表的少数案例中，当这些分子被开出时，患者的视觉功能会变得更糟。在这里，我们介绍了一个因黑色素瘤进展而接受 ICI 治疗的严重 MAR 患者的病例。

方法

一名有睑结膜黑色素瘤病史的 68 岁女性突然出现并逐渐恶化的视力障碍。同时，黑色素瘤的转移性演变被诊断出来并进行了专门的手术治疗。视力评估、静态自动视野测量和 ERG 结果导致 MAR 的诊断。由于全身皮质类固醇治疗并没有改善她的症状，因此反复进行眼内皮质类固醇注射，结果为阳性。后来，患者黑色素瘤的转移进展导致了 pembrolizumab 的出现，pembrolizumab 是一种针对 PD-1 的 ICI。免疫疗法改变了转移性黑色素瘤患者的预后，但这些分子可能会诱发各种免疫相关的不良反应。在我们的例子中，眼内皮质类固醇注射仍同时进行。在治疗过程中进行了视力评估、静态自动视野检查和 ERG。

结果

全视野 ERG 结果表明，尽管继续进行免疫治疗，眼科治疗仍有可能恢复患者的视网膜功能。

结论

我们报告了第一例 ICI 后 1 年阳性结果的 MAR 病例，这可能要归功于玻璃体内皮质类固醇治疗。