| 본문 : Introduction Pembrolizumab, a humanized antibody used in cancer immunotherapy, has been associated with uveitis in 1% of patients, typically involving anterior segment. Here we describe a rare case of sympathetic ophthalmia recurrence with severe annular choroidal detachment after pembrolizumab therapy for lung cancer.
Case presentation A 77-year-old male, who had a history of sympathetic ophthalmia in his left eye four months after he underwent operation for corneal ulcer perforation in his right eye, presented with severe visual impairment in his left eye. He had been diagnosed with small cell lung cancer with bone metastasis and had been administered with pembrolizumab three times four months prior to the presentation. Fundus examination and B-scan ultrasonography showed annular choroidal detachment. Spectral-domain optical coherence tomography showed subretinal and intraretinal fluid involving fovea with choroidal thickening.
Management and outcome Pembrolizumab was immediately discontinued and high dose intravenous prednisolone acetate was initiated. Uveal effusion and subretinal fluid completely resolved three months later, with final visual acuity of 20/125.
Discussion Sympathetic ophthalmia is thought to develop from an autoimmune reaction mainly involving T-cells to ocular antigens exposed during trauma or surgical event. Anti-PD-1 therapy with pembrolizumab may enhance T-cell response and predispose eyes with previous history of sympathetic ophthalmia to recurrence. Clinicians should regularly monitor patients undergoing pembrolizumab treatment for ocular signs or symptoms especially if there is a history of ocular inflammation.
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