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Lama Almulki, Raphael Rosenbaum, David Hinkle, C. Stephen Foster; Anti-ctla-4 Monoclonal Antibody-associated Autoimmune Uveitis. Invest. Ophthalmol. Vis. Sci. 2011;52(14):2925.
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To fully characterize ocular inflammatory diseases resulting from anti CTLA-4 monoclonal antibody-treated stage IV melanoma and further develop a treatment protocol.
Chart review and analysis of anti CTLA-4 monoclonal antibody or ipilimumab-treated melanoma patients who were referred to the Massachusetts Eye Research and Surgery Institution between April 2009 and June 2010. For grading ocular inflammation, the (SUN) Working Group Classification was employed.
Three patients (two males and one female) were identified with the average age of 59.3 years. The duration between symptom onset and the time of presentation varied between 2 days to 2 weeks. Two forms of ocular inflammation were recognized; anterior uveitis (1-4+ cells) in two cases as well as multi focal choroiditis that was confirmed by ICG angiography (two cases) with macular involvement confirmed by macular OCT (one case). BCVA in the worse eye at the time of presentation varied between 20/30 and 20/100. All patients responded to corticosteroid taper (eye drops in one case and orally in the other two) with subsequent improvement in visual acuities (BCVA varied between 20/25-20/30). Ipilimumab therapy was discontinued in all patients with no recurrence of their symptoms.
A vision threatening autoimmune uveitis can develop as a result of anti CTLA-4 monoclonal antibody. Early identification and initiation of therapy with corticosteroids is critical. The risks of discontinuation of ipilimumab therapy must be carefully weighted against the benefits given the poor prognosis of this cohort.
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