RESUMEN
PURPOSE: To characterize the ocular inflammatory side effects associated with immune checkpoint inhibitor (CPI) treatment in a Northern California population. DESIGN: Retrospective case series. PARTICIPANTS: Patients receiving CPI within an integrated healthcare delivery system. METHODS: All patients within Kaiser Permanente Northern California receiving CPI between January 1, 2012 and November 1, 2018 were identified. Medical records of those seen in the ophthalmology clinic at least once were retrospectively reviewed. MAIN OUTCOME MEASURES: Type and duration of ocular inflammation, indication for and exposure to CPI, time from exposure to diagnosis of ocular inflammation. RESULTS: 31 cases of ocular inflammation were identified in 5061 patients (0.61%) receiving CPI. Mean ± SD age was 67 ± 11.9 (range 38-89). Mean time from exposure to diagnosis was 6.8 ± 5.5 months (range 0.5-17). 87% of cases were bilateral, and 43% of cases were chronic. Average ophthalmology follow-up was 16 ± 18 months (range 0-71). 16/31 (52%) had anterior uveitis, 7/31 (23%) had serous retinal detachment or panuveitis resembling Vogt-Koyanagi-Harada syndrome, 4/31 (13%) had papillitis, and 6/31 (19%) had diplopia or ocular motility defect. There was one case each (3.2%) of melanoma associated retinopathy, corneal edema, granulomatous lacrimal gland enlargement, and choroidal neovascularization. CONCLUSIONS: Ocular inflammation is a rare immune associated side effect of CPI treatment, the most common manifestation of which is anterior uveitis.
Asunto(s)
Uveítis Anterior , Uveítis , Síndrome Uveomeningoencefálico , Humanos , Inhibidores de Puntos de Control Inmunológico/efectos adversos , Estudios Retrospectivos , Síndrome Uveomeningoencefálico/diagnóstico , Trastornos de la Visión/tratamiento farmacológico , Uveítis Anterior/tratamiento farmacológico , Enfermedad Aguda , Inflamación/tratamiento farmacológico , Uveítis/tratamiento farmacológicoRESUMEN
Caso clínico: Presentamos el caso de una mujer de 54 años con una coriorretinopatía serosa central diagnosticada erróneamente de enfermedad de Vogt-Koyanagi-Harada y tratada con corticoides sistémicos. La paciente desarrolló un desprendimiento de retina exudativo bulloso en ambos ojos. Discusión: La interrupción del tratamiento con corticoides junto con el drenaje quirúrgico del líquido subretiniano y la aplicación de terapia fotodinámica consiguió la mejoría anatómica y funcional. El correcto diagnóstico de las formas atípicas de la enfermedad podría evitar las complicaciones del uso inadecuado de los corticoides (AU)
Case report: The case is presented on a 54-year-old woman with a central serous chorioretinopathy, misdiagnosed as Vogt-Koyanagi-Harada disease, and treated with systemic corticosteroids. The patient presented with a bilateral bullous exudative retinal detachment. Discussion: Discontinuation of corticosteroid therapy, surgical drainage of subretinal fluid, and photodynamic therapy, led to anatomical and functional improvement. The recognition of an atypical presentation of central serous chorioretinopathy may avoid complications of the inappropriate treatment with corticosteroids (AU)
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Desprendimiento de Retina/complicaciones , Coriorretinopatía Serosa Central/complicaciones , Corticoesteroides/uso terapéutico , Síndrome Uveomeningoencefálico/diagnóstico , Diagnóstico Diferencial , Vitrectomía/métodos , Fototerapia/métodos , DrenajeRESUMEN
CASE REPORT: We describe a case of serous retinal detachment as an atypical presentation of bilateral chronic central serous chorioretinopathy, DISCUSSION: We present its differential diagnosis and therapeutical management with low-fluence photodynamic therapy, achieving satisfactory anatomical and functional results.
Asunto(s)
Coriorretinopatía Serosa Central/complicaciones , Fotoquimioterapia , Desprendimiento de Retina/tratamiento farmacológico , Adulto , Vesícula/tratamiento farmacológico , Vesícula/etiología , Coriorretinopatía Serosa Central/diagnóstico , Enfermedad Crónica , Ciclosporina/uso terapéutico , Diagnóstico Diferencial , Errores Diagnósticos , Angiografía con Fluoresceína , Humanos , Terapia por Luz de Baja Intensidad , Masculino , Porfirinas/uso terapéutico , Prednisona/uso terapéutico , Desprendimiento de Retina/etiología , Desprendimiento de Retina/cirugía , Epitelio Pigmentado de la Retina/patología , Tomografía de Coherencia Óptica , Síndrome Uveomeningoencefálico/diagnóstico , Verteporfina , VitrectomíaRESUMEN
A case of Vogt-Koyanagi-Harada disease (VKH) that developed in a 36-year-old woman with Graves' disease was described. The patient was treated with Lugol's solution and presented with bilateral serous retinal detachment. She had also suffered from methimazole-induced hypersensitivity and steroid-induced myopathy. Fluorescein angiography showed multiple leakage points and a lumbar puncture revealed pleocytosis, which was compatible with VKH. High dose steroid pulse therapy was successful. Altered immune regulation associated with drug-induced hypersensitivity may contribute to the development of VKH in patients with Graves' disease.