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Show Poster 21 Bilateral optic neuropathy following treatment with nivolumab for metastatic cutaneous melanoma Maria Mayorga1, Carolina Gentile1, Yamila Müller1, Alejo Quiñones Maffassanti1, Jorge Norscini1 Hospital Italiano de Buenos Aires, Buenos Aires, Argentina 1 Introduction: Immune checkpoint inhibitors are powerful tools in the management of malignancy. Their mechanism of action is inducing an endogenous autoimmune state to fight metastatic cancers. However, they have been associated with systemic and ocular side effects. The purpose is to describe an ophthalmic side effect of nivolumab in a patient with metastatic cutaneous melanoma. Description of Case(s): A 71 year old male presented with dimmed vision and dyschromatopsia in both eyes for 3 months. He had a history of stage III metastatic cutaneous melanoma treated with ipilimumab+nivolumab (4 cycles), then nivolumab (24 cycles), with good tumor control. Presenting visual acuity was 20/20 OU, with normal pupil response. Fundus examination showed mild bilateral optic nerve edema, visual fields (VF) showed marked constriction. Treatment with nivolumab was discontinued. Head and orbit MRI and spinal fluid were normal. Serology for atypical optic neuropathies and paraneoplastic syndromes was negative. Follow-up VF worsened, with constriction 10° from fixation OU and decreased VA in OS. Treatment was initiated with prednisone with no response, then plasma exchange (PLEX) was performed with significant improvement in VF, VA and dyschromatopsia for 3 weeks. At which point, VF and dischromatopsia started to worsen progressively, and VA decreased to 20/40 OU, so a new round of PLEX was performed and azatioprine was started, with no further decline of vision or visual fields. OCT shows marked loss of fibers OU. Conclusions, including unique features of the case(s): Checkpoint inhibitors are new tools in the management of previously incurable malignancies. Although ocular immune related adverse events are rare, they should be considered after starting nivolumab and even after cessation of the medication. Every patient with a history of metastatic malignancy treated with nivolumab presenting with new ocular symptoms must be examined to rule out side effects of checkpoint inhibitors. Also a choroidal mass due to metastatic disease and paraneoplastic syndromes should be considered. References: None. Keywords: Optic neuropathy, Neuro-ophth & systyemic disease ( eg. MS, MG, thyroid) Financial Disclosures: The authors had no disclosures. Grant Support: None. 2019 Annual Meeting Syllabus | 77 |
