difluprednate and Papilledema

To describe the clinical course of uveitis-associated inflammatory papillitis and evaluate the utility and reproducibility of optic nerve spectral domain optical coherence tomography (SD-OCT).. Data on 22 eyes of 14 patients with uveitis-related papillitis and optic nerve imaging were reviewed. SD-OCT measure reproducibility was determined and parameters were compared in active vs. inactive uveitis.. Papillitis resolution lagged behind uveitis resolution in three patients. For SD-OCT measures, the intraclass correlation coefficients were 99.1-100% and 86.9-100% for intraobserver and interobserver reproducibility, respectively. All SD-OCT optic nerve measures except inferior and nasal peripapillary retinal thicknesses were significantly higher in active vs. inactive uveitis after correction for multiple hypotheses testing. Mean optic nerve central thickness decreased from 545.1 to 362.9 µm (p = 0.01).. Resolution of inflammatory papillitis can lag behind resolution of uveitis. SD-OCT assessment of papillitis is reproducible and correlates with presence vs. resolution of uveitis.

Topics: Administration, Topical; Adolescent; Adult; Aged; Child; Drug Monitoring; Female; Fluprednisolone; Glucocorticoids; Humans; Immunosuppressive Agents; Infliximab; Male; Methotrexate; Middle Aged; Nerve Fibers; Observer Variation; Ophthalmic Solutions; Optic Disk; Optic Nerve; Papilledema; Reproducibility of Results; Retinal Ganglion Cells; Retrospective Studies; Tomography, Optical Coherence; Triamcinolone Acetonide; Uveitis

Drug-induced uveitis is a well-known effect of ocular inflammation that has been reported with many medications. Pembrolizumab is a newer generation of the anti-programmed cell death-1 monoclonal antibodies that was recently approved by the Food and Drug Administration for the treatment of advanced melanoma. Immune-mediated adverse events involving different organs have been reported in recent literature in association with this drug. We present the first reported case of uveitis in association with pembrolizumab therapy.. An 82-year-old man with stage IV melanoma was started on pembrolizumab infusion treatment every 3 weeks. Two months after initiating therapy, he presented with bilateral severe anterior uveitis and papillitis with fast and complete recovery after withholding further pembrolizumab infusions and treatment with topical steroid. Uveitis recurred after restarting pembrolizumab therapy.. In current clinical practice, many new drugs are being approved, requiring better characterization of the prevalence, onset, and nature of adverse events in order to aid development of effective management strategies. Ophthalmologists should keep in mind that drugs are always a possible cause of ocular inflammation in patients presenting with uveitis.

Topics: Aged, 80 and over; Antibodies, Monoclonal, Humanized; Antineoplastic Agents; Fluprednisolone; Glucocorticoids; Humans; Infusions, Intravenous; Male; Melanoma; Neoplasm Recurrence, Local; Neoplasm Staging; Papilledema; Skin Neoplasms; Uveitis, Anterior; Visual Acuity; Visual Fields