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Outcomes Associated With Sustained-Release Intraocular Fluocinolone Implants in a Case of Melanoma-Associated Retinopathy Treated Without Systemic Immunosuppression

Karatsai, Eleni, Robson, Anthony G. and Taylor, Simon R.J. (2019) Outcomes Associated With Sustained-Release Intraocular Fluocinolone Implants in a Case of Melanoma-Associated Retinopathy Treated Without Systemic Immunosuppression JAMA Ophthalmology, 137 (5). pp. 564-567.

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Importance: Melanoma associated retinopathy (MAR) is a paraneoplastic syndrome in which anti-retinal antibodies cross-react with retinal on-bipolar cells, resulting in night blindness and progressive visual field loss. Current therapeutic options include cytoreductive surgery in combination with immunoglobulin (IVIg), corticosteroids or plasmapheresis, but their effectiveness is limited and there is concern given the possible protective role of circulating autoantibodies against metastatic spread. We report here three-year follow-up of the first case of MAR treated with intravitreal long-acting steroid implants. Objectives: To report a case of MAR which was treated with intravitreal fluocinolone acetonide implants (FAc; Iluvien) in the absence of systemic immunosuppression.

Design, Setting and Participants: Three-year follow-up of a 73 year-old woman with a history of surgical excision of a malignant melanoma of the left pinna who presented with visual symptoms of shimmering and nyctalopia. Fundus examination, fundus autofluorescence and optical coherence tomography were normal with no evidence of cystoid macular edema. Automated perimetry showed a reduction in visual field and full-field electroretinography (ERG) demonstrated findings consistent with generalized on-bipolar cell dysfunction, typical of MAR. The patient was treated with bilateral FAc intravitreal implants.

Main outcomes and measures: Visual acuity, visual field and ERG testing for three years following treatment. Results: Visual fields and ERGs improved and, at three years post treatment, the patient remained visually stable and in systemic disease remission.

Conclusions and relevance: We report to our knowledge the first case of MAR treated with intravitreal slow-release corticosteroid implants, showing improvements in visual symptoms, visual fields and retinal function. Detailed ERG monitoring indicated characteristic ERG abnormalities that partly resolved following treatment, consistent with improved inner retinal on-bipolar cell function. Sustained-release intraocular steroid implants may offer an effective and safe alternative to systemic immunosuppression in MAR although results from one case should be generalized with caution.

Item Type: Article
Divisions : Faculty of Health and Medical Sciences > School of Biosciences and Medicine
Authors :
Karatsai, Eleni
Robson, Anthony G.
Taylor, Simon
Date : 21 March 2019
Funders : NHS, National Institute for Health Research (NIHR)
DOI : 10.1001/jamaophthalmol.2019.0284
Copyright Disclaimer : © 2019 American Medical Association. All rights reserved.
Uncontrolled Keywords : Melanoma-associated retinopathy; MAR; Fluocinolone acetonide; Retinopathy; Nyctalopia; Electroretinography; ERG
Depositing User : Clive Harris
Date Deposited : 06 Mar 2019 11:29
Last Modified : 25 Jan 2020 02:08

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