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Recurrent grade 4 panuveitis with serous retinal detachment related to nivolumab treatment in a patient with metastatic renal cell carcinoma

  • Wei Wang
  • Wai-Ching Lam
  • Ling Chen
Original Article

Abstract

Blockade of programmed cell death-1 (PD-1) has become one of the most promising immunotherapies for many human cancers. However, immune-related adverse events can be produced by anti-PD-1 therapy. Uveitis is a rare but potentially devastating side effect of anti-PD-1 therapy. Delay in diagnosis or improper treatment may eventually lead to irreversible blindness. Therefore, it is important for the oncologist and the ophthalmologist to recognize and manage this adverse event properly in patients receiving anti-PD-1 therapy in a timely manner. Here we present a grade 4 panuveitis with bilateral serous retinal detachment following treatment with nivolumab for metastatic renal cell carcinoma. Oral prednisone, topical steroid eye drops, periorbital injection of steroid and finally intravitreal injection of steroid implant were administered in our patient. We observed that intravitreal injection of dexamethasone implant, but not the periorbital injection of steroid or the steroid eye drops, was effective to control the posterior uveitis and serous retinal detachment. Oral prednisone was also effective, but it might affect the efficacy of anti-PD-1 therapy and promote tumor growth. We also summarize 15 cases of uveitis reported to date related to nivolumab or pembrolizumab therapy in the present study. The symptoms, signs, potential underlying mechanisms and treatment options regarding this adverse event are discussed.

Keywords

Uveitis Anti-PD-1 Retinal detachment Dexamethasone implant 

Abbreviations

AC

Anterior chamber

BCVA

Best-corrected visual acuity

CTCAE

Common terminology criteria for adverse events

CTLA-4

Cytotoxic T-lymphocyte antigen-4

EAU

Experimental autoimmune uveitis

FDA

Food and Drug Administration

FFA

Fluorescent fundus angiography

irAEs

Immune-related adverse events

NSCLC

Non-small cell lung cancer

OCT

Optical coherence tomography

PD-1

Programmed cell death-1

PD-L1/L2

Programmed cell death ligand 1/ligand 2

VA

Visual acuity

Notes

Author contributions

All authors, WW, W-CL and LC, take responsibility for the integrity of the data. All authors made substantial contributions to data interpretation, discussion, manuscript preparation, review, revision and final approval.

Funding

This study was funded by grants from the National Natural Science Foundation of China (No. 81870660), the Shanghai Science and Technology Foundation (18ZR1405900) and the Shanghai Hospital Development Center (SHDC12016116).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Written informed consent was obtained from the patient for publication of this case report.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Shanghai Medical CollegeFudan UniversityShanghai, 200031China
  2. 2.Key Laboratory of Myopia of State Health Ministry (Fudan University) and Laboratory of Myopia, Chinese Academy of Medical SciencesShanghai, 200031China
  3. 3.Department of Ophthalmology, Li Ka Shing Faculty of MedicineThe University of Hong KongHong KongChina

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