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This case report describes a woman who presented with bilateral blurry vision a few days after dyeing her hair with hair dye containing aromatic amines.
RESUMO
Neovascular age-related macular degeneration (nAMD) remains a major cause of visual impairment and puts considerable burden on patients and health care systems. l-DOPA-treated Parkinson's disease (PD) patients have been shown to be partially protected from nAMD, but the mechanism remains unknown. Using murine models that combine 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine-induced (MPTP-induced) PD and laser-induced nAMD with standard PD treatment of l-DOPA/DOPA-decarboxylase inhibitor or specific dopamine receptor inhibitors, we here demonstrate that l-DOPA treatment-induced increase of dopamine-mediated dopamine receptor D2 (DRD2) signaling inhibits choroidal neovascularization independently of MPTP-associated nigrostriatal pathway lesion. Analyzing a retrospective cohort of more than 200,000 patients with nAMD receiving anti-VEGF treatment from the French nationwide insurance database, we show that DRD2 agonist-treated PD patients have a significantly delayed age of onset of nAMD and reduced need for anti-VEGF therapies, similar to the effects of the l-DOPA treatment. While providing a mechanistic explanation for an intriguing epidemiological observation, our findings suggest that systemic DRD2 agonists might constitute an adjuvant therapy to delay and reduce the need for anti-VEGF therapy in patients with nAMD.
Assuntos
Neovascularização de Coroide , Levodopa , Degeneração Macular , Doença de Parkinson , Receptores de Dopamina D2 , Idoso , Animais , Humanos , Masculino , Camundongos , Neovascularização de Coroide/tratamento farmacológico , Neovascularização de Coroide/patologia , Neovascularização de Coroide/metabolismo , Agonistas de Dopamina/uso terapêutico , Levodopa/efeitos adversos , Degeneração Macular/tratamento farmacológico , Degeneração Macular/patologia , Camundongos Endogâmicos C57BL , Doença de Parkinson/tratamento farmacológico , Receptores de Dopamina D2/metabolismo , Estudos Retrospectivos , Fator A de Crescimento do Endotélio Vascular/metabolismoRESUMO
Vogt-Koyanagi-Harada (VKH) syndrome is a rare condition implicating systemic immune reaction against melanocytes. The pathophysiology is unclear. A genetic predisposition has been suggested as HLA-DR4/DRB1*04 is more common among VKH patients. Drug induced VKH syndrome has been reported in advanced melanoma patients receiving immunotherapy, including ipilimumab and adoptive cell transfer of Tumor-Infiltrating Lymphocyte associated with IL-2. To date, no case of anti PD-1 -induced VKH syndrome has been described. We report here the case of a HLA-DR4/DRB1*04 patient successfully treated with anti PD-1 for advanced melanoma who developed a systemic immune reaction against melanocytes for whom we discuss a VKH-like syndrome diagnosis in a potentially genetically predisposed patient.