Immunotherapy leads to significantly prolonged survival of patients with metastatic melanoma. Autoimmune side effects including colitis, dermatitis, and endocrine abnormalities are common in patients treated with ipilimumab [anti-CTLA4 (cytotoxic T-lymphocyte-associated protein 4)]. Antibodies such as pembrolizumab that interfere with the PD-1 (programmed cell death 1)/PD-L1 pathway show greater efficacy and less toxicity than ipilimumab. Here we report 2 cases of pembrolizumab-induced uveitis associated with complete or partial tumor response. We suggest that uveitis may serve as a surrogate marker for a tumor response to therapy with pembrolizumab.

Zusammenfassung Hintergrund Die akute makuläre Neuroretinopathie (AMNR) ist eine seltene, ein- oder beidseitige Erkrankung der Makula. Betroffene Patienten, zumeist junge Frauen, beklagen plötzlich aufgetretene Zentralskotome. Diese korrespondieren mit scharf begrenzten rötlich-braunen makulären Läsionen. Ophthalmoskopisch sind sie häufig kaum auszumachen, eine deutlich bessere Darstellung erlaubt das Infrarotreflexionsbild. Es zeigt sich eine oft blütenartige Gruppierung der flachen ovalen oder keilförmigen Einzelläsionen um die Fovea. Patienten und Methoden Retrospektive Fallserie von 4 Patienten mit AMNR. Die klinisch-morphologischen Merkmale werden unter Berücksichtigung verschiedener bildgebender Verfahren demonstriert. Ergebnisse 4 junge Frauen (26, 27, 28, 29 Jahre) bemerkten plötzlich aufgetretene Flecken im zentralen Gesichtsfeld. In 3 Fällen bestanden diese beidseits. Drei Frauen berichteten über grippale Prodromi. Bei allen 4 Patientinnen zeigten sich bei voller Sehschärfe unauffällige vordere und hintere Augenabschnitte. Die korrespondierenden retinalen Läsionen wurden erst in der Infrarotaufnahme der optischen Kohärenztomografie (OCT) entdeckt. In der OCT zeigten sich im Läsionsbereich dezente Defekte im Bereich der Fotorezeptoraußensegmente. Die Nachbeobachtungszeit betrug zwischen 9 und 36 Monaten. Es zeigte sich bei allen Patientinnen eine Regredienz der Symptomatik mit zumindest partieller Erholung der Netzhautarchitektur. Schlussfolgerung Patienten mit AMNR erleben plötzlich auftretende ein- oder beidseitige Skotome im zentralen Gesichtsfeld bei oft nur geringer Beeinträchtigung der Sehschärfe. Die Prognose ist unterschiedlich; so gibt es Verlaufsformen mit Selbstlimitierung und völliger Regredienz der Läsionen, aber auch persistierende Visusreduktionen. Bei fehlender kausaler Therapieoption wird zumeist ein exspektatives Management favorisiert.

A case is reported of a 67-year-old female patient, in whom a fungal endophthalmitis occurred 6 years after trabeculectomy. Pseudallescheria Boydii was isolated. This organism is a rare cause of infection. In the literature only 14 cases of keratitis and 8 cases of endophthalmitis have been reported. Miconazole is the therapy of choice. However in 55% of the published cases, (as in the one reported here), an exenteration or enucleation of the affected bulbus was necessary.

Objective To investigate the association between the central retinal thickness (CRT), the retinal nerve fibre layer thickness (RNFL), and the functional alterations in retinitis pigmentosa (RP) patients. Methods Forty-three patients with typical RP and nineteen age-matched controls, who underwent SD-OCT (macular and optic disc OCT protocols) and electrophysiology, were included. The RP group was divided into two subgroups: with clinical appearance of macular oedema (ME-RP; 30 eyes) and without macular oedema (no-ME; 44 eyes). Central retinal thickness OCT data were averaged in three zones (zone 1 [0°–3°], zone 2 [3°–8°], and zone 3 [8°–15°]) and were evaluated in relation to the RNFL thickness and electrophysiological data. Results The ME-RP group showed increased CRT (zone 1) and RNFL thickness compared to the controls and no-ME-RP (p ≤ 0.002). The no-ME-RP group had reduced CRT thickness (all zones; p ≤ 0.018) compared to the controls and ME-RP, whereas the RNFL thickness in the no-ME-RP group was reduced only compared to the ME-RP group (p < 0.001). The ME-RP group showed significantly more attenuated functional responses than the no-ME-RP patients. A significant positive interaction was found between the CRT (zones 1 and 2) and the RNFL thickness within ME-RP (p ≤ 0.010). Significant negative interactions were found between CRT, RNFL thickness, and functional findings within ME-RP (p ≤ 0.049). Conclusion The presence of macular oedema correlated well with increased RNFL thickness and residual function in RP patients. Such association provides evidence of an underlying transneuronal mechanism of retinal degeneration. Simultaneous monitoring of CRT and RNFL thickness may help in the future to evaluate the progression of the disease and the efficacy of treatments in RP patients.

Purpose To describe choroidal findings associated with disseminated systemic non-mycobacterial infection. Methods A retrospective observational case series included two patients (four eyes) with non-tuberculous mycobacterial disease. The activity of choroidal lesions was assessed by clinical examination, supported by colour fundus photography, fundus autofluorescence imaging, indocyanine green angiography, fluorescence angiography, and optical coherence tomography (OCT) angiography. The relationships between clinical symptomatology, choroidal findings, and systemic disease activity were evaluated. Results One subject diagnosed with aortic graft infection showed positive cultures for Mycobacterium chimaera. One HIV-positive subject showed a positive saliva culture for Mycobacterium avium. At presentation, all subjects showed chorioretinal manifestation. In one patient, the lesions were active and in the other patient, the lesions appeared inactive. With activity of disseminated chorioretinitis, the lesions had indistinct, blurred borders on fluorescence angiography and indocyanine green angiography and were hyporeflective with well-defined borders on OCT imaging. Conclusion Multimodal imaging enables distinction between active and inactive lesions, thus supporting therapeutic management. Choroidal presentation of active disseminated mycobacterium infection indicates activity of systemic disease. Thus, even if the patient is not immunocompromised, an underlying systemic involvement should be ruled out.