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Goncalo A C Almeida, Richard Bernhardt, Ciara O'Hanlon Brown; Clinical course and characteristics of uveitis associated with metastatic melanoma chemotherapy with Ipilimumab and Nivolumab. Invest. Ophthalmol. Vis. Sci. 2018;59(9):4210.
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© ARVO (1962-2015); The Authors (2016-present)
Ipilimumab and Nivolumab are promising treatments for patients with metastatic melanoma. However their multiple side-effects, have been reported. Published data incidence reports uveitis as affecting 4-12% of patients treated.We performed a retrospective observational clinical study of our treated patients in Kent Oncology Centre and Eye Unit. Our hypothesis was that the incidence and severity of uveitis was understated.
We analyzed our existing treated metastatic melanoma base for presence of uveitis from 2014-2017. In patients where uveitis was detected, the clinical characteristics, management and clinical course were collected and described for interpretation.
20 patients were treated in the period described. Of these 4 (20%) developed uveitis seen in our Eye Unit. All had bilateral involvement. 3 patients developed posterior uveitis, with specific phenotypes, 1 with a VKH-like illness and exudative detachments, 1 with severe bilateral panuveitis with choroidal granulomas, 1 developed depigmentation of the fundus involving the macula. 1 presented with anterior uveitis.All eyes with posterior uveitis had vision loss at presentation. This improved on all with systhemic immunosuppression with steroids, with areas of permanent depigmentation present. The patient with depigmentation phenotype required additional immunomodulation with azathioprine, which halted progression. The patient with anterior uveitis was managed with topical steroids, with good result. All patients with posterior uveitis halted further chemotherapy.
Our single-centre results were collected retrospectively and present limitations pertaining to the small sample size and type of study. However, the incidence of uveitis seems higher on our centre (20%) relative to the published results. In addition the severity of the ocular inflammation is worse than the initial studies reporting on metastatic melanoma. In the author’s opinion this is new information, and should be further researched prospectively
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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