Birdshot-like Chorioretinopathy Associated With Pembrolizumab Treatment

Implications of Birdshot-Like Uveitis on the Pathogenesis of Birdshot Chorioretinopathy

“…The researchers 2 evaluated 559 546 patients who had cataract surgery in at least 1 eye. The association between cataract surgery and crash involvement has been previously reported by Owsley et al 1 This study found that patients with cataract who underwent cataract surgery experienced only half the crash risk compared with patients with similar conditions who did not undergo surgery. An Australian study 3 based on similar linked administrative data also found cataract surgery is effective in reducing car crashes.…”

“…There is also a rare association of BCR with ocular melanoma, further supporting a role for neoplasia inciting the disease. 3 In the case presented by Acaba-Berrocal et al, 1 we propose that immune activation through release of inhibition of the programmed cell death protein 1 checkpoint pathway in a patient treated for cutaneous melanoma mimics the altered immune reactivity to neoplastic changes in the skin (whether manifest or microscopic) in a subset of individuals who are HLA-A29-positive and develop BCR. Cancer immunosurveillance could lead to initiation of BCR through antigenic mimicry involving presentation on HLA-A29 or loss of immunological tolerance.…”

“…In Reply We read with interest the letter from Sun et al regarding possible pathophysiologic implications of our article on birdshot-like chorioretinopathy associated with pembrolizumab treatment. 1 In the article, we observed a single patient who was treated for cutaneous melanoma with a checkpointinhibitor agent directed against the programmed cell death-1 receptor on T cells and soon thereafter developed a classicappearing case of birdshot chorioretinopathy (BCR) in both eyes. Testing for HLA-A29 was negative.…”

“…To the Editor Cataracts are a leading cause of reversible vision impairment worldwide, and age-associated decline in visual acuity has been associated with increased risk for car crashes and falls. 1 A recent, methodologically strong, population-based study 2 has found that the rate of serious car crashes decreased by 9% after cataract surgery. The researchers 2 evaluated 559 546 patients who had cataract surgery in at least 1 eye.…”

“…While filling Scantron forms requires motor actions that reading does not, visual scanning is required to identify the circled answers and locate the corresponding answer bubbles. This engages oculomotor and visual skills in common with reading (eg, saccades, 1,2 accommodation, near vision). Therefore, reading-associated factors may be associated with performance on both tasks.…”