<p>A Case Of Ipilimumab-Induced Unusual Serous Retinal Detachment In Bilateral Eyes</p>

Abstract

PurposeIpilimumab is an immune checkpoint inhibitor that is now widely used for patients with metastatic malignant melanoma. However, this immune checkpoint inhibitor can induce related adverse events in various organs. Here, we report a case of bilateral drug (ipilimumab)-induced serous retinal detachment (SRD), and the characteristic features found during swept-source optical coherence tomography (SS-OCT).CaseA 78-year-old man with metastatic melanoma received 4 cycles of dacarbazine, nimustine, vincristine, and interferon-beta starting in January 2014, followed by 47 cycles of nivolumab starting in September 2014. Treatment with ipilimumab was started in June 2017. After 2 cycles of ipilimumab, the patient noticed impairment of the visual field in both of his eyes (at day 22) and visited our department in August 2017. Best corrected visual acuity at this initial visit was 16/20 in both eyes, while a fundus examination revealed SRD and retinal pigment epithelial detachments in both eyes. When using the horizontal and vertical 12 mm B-scanned images of SS-OCT, we detected SRD accompanied by a widely distributed high reflection of the photoreceptor outer segment, including the area where the SRD appeared. In addition, the image also showed the interdigitation zone was indistinguishable. Fluorescein angiography showed little leakage in the maculae. During his course of follow-up examinations, there was an increase in the SRD at the beginning, after which it then gradually decreased. However, the obscurity of the interdigitation zone remained.ConclusionIpilimumab may cause impairment of the outer retinal layer. We suggest that this is a presumed ipilimumab-induced SRD.

Bilateral multiple serous retinal detachments after treatment with nivolumab: a case report

“…There have also been reports of ipilimumab, an antibody inhibiting the cytotoxic T lymphocyte (T-cells)-associated antigen 4 (CTLA-4) molecule, i.e. another immune-checkpoint inhibitor, showing OCT findings closely resembling those of our case [11,12]. The RPE cells express CD68 molecules which interact with CTLA-4 [2].…”

Micro-abnormalities in the retina and choroid induced by anti-CTLA4 treatment

“…One patient with malignant melanoma who was treated with an anti-CTLA4 agent at our institution exhibited bilateral serous retinal detachments (SRDs) 22 days after treatment. In this case, SRD was accompanied by elongation of the outer photoreceptor segment, both within and beyond the area of SRD, and SRD persisted without complete resolution 9 . A similar case was reported in a patient treated with PD1 inhibitors, who experienced poor recovery of visual function 10 .…”

“…Clinically, subretinal fluid accumulation and macular oedema can occur following anti-CTLA4 treatment, with some patients also experiencing deterioration of visual function 5 , 9 , 10 . In this study, we utilized OCT to examine the emergence of macular oedema during anti-CTLA4 injection; however, no exudative changes were detected in the retinas of experimental mice.…”

Bilateral Posterior Uveitis and Retinal Detachment During Immunotherapy: A Case Report and Literature Review

“…We also searched published literature regarding ICI-related retinal detachment, identifying nine cases with retinal detachment in patient receiving ICIs ( Table 2) (30)(31)(32)(33)(34)(35)(36)(37)(38). Among them, most of the cases reported were anti-CTLA-4 antibodies.…”