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CHOROIDAL NEOVASCULAR MEMBRANES ASSOCIATED WITH PAPILLITIS IN A PATIENT ON CHECKPOINT INHIBITOR
Tian Xia1,2, Peter Bracha2,3, Nirali Bhatt2
1Retina Vitreous Consultants, Livingston, New Jersey.
Purpose:
The purpose of this study was to describe a case of bilateral peripapillary choroidal neovascular membranes in the setting of a patient with papillitis associated with pembrolizumab for Stage IIIA adenocarcinoma of the lung.
Methods:
This was a retrospective case report with fundus photography, fluorescein angiography, optical coherence tomography, and optical coherence tomography angiography.
Results:
A 59-year-old woman with Stage IIIA adenocarcinoma of the lung on pembrolizumab therapy presented with symptoms of blurry vision. She was found to have bilateral papillitis with right eye peripapillary subretinal hemorrhage and serous retinal detachment involving the fovea. Fluorescein angiography suggested peripapillary neovascularization with leakage in both eyes. Intravitreal bevacizumab injections were given in both eyes on a monthly basis with dramatic resolution of subretinal hemorrhage and fluid and control of peripapillary choroidal neovascular membranes.
Conclusion:
Pembrolizumab has been associated with many ocular adverse effects, and to the best of our knowledge, we report the first case of pembrolizumab associated with papillitis and peripapillary choroidal neovascular membranes. Control of the neovascularization was achieved with antivascular endothelial growth factor therapy.
Insights
This case report details a patient with lung cancer experiencing vision loss due to papillitis and choroidal neovascular membranes linked to pembrolizumab. Treatment with anti-VEGF therapy successfully resolved these ocular complications.
Area of Science:
- Ophthalmology
- Oncology
- Immunology
Background:
- Pembrolizumab, an immune checkpoint inhibitor, is used for advanced lung cancer.
- Ocular adverse effects are known complications of pembrolizumab therapy.
- Peripapillary choroidal neovascular membranes (CNVM) are a rare but serious ocular condition.
Observation:
- A 59-year-old woman with Stage IIIA lung adenocarcinoma developed bilateral papillitis and CNVM during pembrolizumab treatment.
- Symptoms included blurry vision, subretinal hemorrhage, and serous retinal detachment.
- Diagnostic imaging confirmed papillitis and peripapillary neovascularization with leakage.
Findings:
- The patient presented with bilateral papillitis and peripapillary CNVM.
- Intravitreal bevacizumab injections led to resolution of hemorrhage and fluid.
- CNVM were effectively controlled with anti-vascular endothelial growth factor (VEGF) therapy.
Implications:
- This is the first reported case of pembrolizumab-associated papillitis and peripapillary CNVM.
- Ophthalmologists should be vigilant for ocular side effects in patients on pembrolizumab.
- Anti-VEGF therapy appears effective in managing this specific complication.
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