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Brief Report |

Chorioretinal Lesions in a Case of Melanoma-Associated Retinopathy Treated With Pembrolizumab ONLINE FIRST

Philipp Roberts, MD1,2; Gerald A. Fishman, MD3; Komal Joshi, MD1; Lee M. Jampol, MD1
[+] Author Affiliations
1Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
2Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
3The Chicago Lighthouse for People Who Are Blind or Visually Impaired, Chicago, Illinois
JAMA Ophthalmol. Published online August 18, 2016. doi:10.1001/jamaophthalmol.2016.2944
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Importance  In recent years, the treatment of patients with advanced cutaneous melanoma has undergone substantial changes. Patients can now be offered treatment with immune checkpoint inhibitors, which are capable of increasing patient survival. However, these new treatments are associated with immune-related adverse effects that can involve different organ systems, including the eye.

Observations  We describe the case of a patient who received a diagnosis of metastatic cutaneous melanoma and developed melanoma-associated retinopathy with unanticipated fundus findings while receiving treatment with the immune checkpoint inhibitor pembrolizumab. Chorioretinal scars with pigment accumulations developed in the retinal periphery in both eyes.

Conclusions and Relevance  Immune checkpoint inhibitors, which are now being used more commonly for patients with advanced stages of melanoma, can exacerbate autoimmune diseases in patients with underlying clinical or latent autoimmunity. Clinicians should be aware of atypical eye findings, including chorioretinal scars.

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Figure 1.
Fundus Photography and Optical Coherence Tomography of Fundus Lesions in the Right Eye

Color fundus photography montage (A-C) and infrared en face (D and F) and spectral-domain optical coherence tomographic (SD-OCT) B-scans (Spectralis HRA+OCT; Heidelberg Engineering) (E and G) of the patient’s right eye. Chorioretinal lesions can be seen in the peripheral retina. The green arrows indicate the location of the SD-OCT B-scans.

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Figure 2.
Fundus Photography and Optical Coherence Tomography of Fundus Lesions in the Left Eye

Color fundus photography montage (A and B) and infrared en face (C) and spectral-domain optical coherence tomographic (SD-OCT) B-scan (D) of the patient’s left eye. Note the depigmented lesions with pigment clumping in the center in the enlarged segment of the color fundus photograph (B). The green arrows indicate the location of the SD-OCT B-scan.

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Figure 3.
Fluorescein Angiographic Features of the Lesions in the Right and the Left Eye

Late-phase fluorescein angiography of the patient’s right (A) and left (B) eye revealing “window defects” without leakage in areas of fundus lesions. There is hypofluorescence consistent with a blockage of the fluorescent signal in areas of pigment clumping.

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