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Ocular changes in metastatic melanoma patients treated with MEK inhibitor cobimetinib and BRAF inhibitor vemurafenib

Ana Ursula Gavric

Ana Ursula Gavric

Eye Hospital, University Medical Centre LjubljanaLjubljana, Slovenia
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Gavric, Ana Ursula
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Janja Ocvirk

Janja Ocvirk

  • Department of Medical Oncology, Institute of Oncology LjubljanaLjubljana, Slovenia
  • Faculty of Medicine, University of LjubljanaLjubljana, Slovenia
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Ocvirk, Janja
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Polona Jaki Mekjavic

Polona Jaki Mekjavic

  • Eye Hospital, University Medical Centre LjubljanaLjubljana, Slovenia
  • Faculty of Medicine, University of LjubljanaLjubljana, Slovenia
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Mekjavic, Polona Jaki
  
Jan 24, 2018
Ocular changes in metastatic melanoma patients treated with MEK inhibitor cobimetinib and BRAF inhibitor vemurafenib's Cover Image
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Article Category: Research Article
Published Online: Jan 24, 2018
Page range: 213 - 219
Received: Oct 04, 2017
Accepted: Nov 20, 2017
DOI: https://doi.org/10.2478/raon-2018-0002
Keywords
© 2018 Ana Ursula Gavric, Janja Ocvirk, Polona Jaki Mekjavic, published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Figure 1

(A) Discrete bilateral lesions in the fovea seen on fundus photography(blue arrows); (B) Infrared reflectance imaging showing lesions with a hyperreflective center, surrounded by a hyporeflective zone scattered throughout the posterior pole (some are marked with red arrows); (C) Some lesions showed increased signal in autofluorescence imaging (some are marked with yellow arrows).
(A) Discrete bilateral lesions in the fovea seen on fundus photography(blue arrows); (B) Infrared reflectance imaging showing lesions with a hyperreflective center, surrounded by a hyporeflective zone scattered throughout the posterior pole (some are marked with red arrows); (C) Some lesions showed increased signal in autofluorescence imaging (some are marked with yellow arrows).

Figure 2

(A-C) IR imaging of foveal lesion during cycles; (D-F) OCT showed fluctuations of dome-shaped accumulation of subretinal fluid with elongation of interdigitation zone (green arrows) in the foveal region; A+D = imaging during 3rd cycle; B+E = imaging during 6th cycle; C+F = imaging during 8th cycle.
(A-C) IR imaging of foveal lesion during cycles; (D-F) OCT showed fluctuations of dome-shaped accumulation of subretinal fluid with elongation of interdigitation zone (green arrows) in the foveal region; A+D = imaging during 3rd cycle; B+E = imaging during 6th cycle; C+F = imaging during 8th cycle.

Figure 3

Fluorescein (A, B) and indocyanine green (C, D) angiography showed only mild masking effect of subretinal fluid on the location of lesions (red arrows).
Fluorescein (A, B) and indocyanine green (C, D) angiography showed only mild masking effect of subretinal fluid on the location of lesions (red arrows).

Figure 4

Discrete morphological changes with focal elongations of interdgitation zone in the fovea (red arrows) and near the vascular arcades (green arrows) seen on OCT.
Discrete morphological changes with focal elongations of interdgitation zone in the fovea (red arrows) and near the vascular arcades (green arrows) seen on OCT.

Patient characteristics

Patient N° 1 2 3 4 5 6 7
Sex M M F M M M M
Age (years) 41 58 64 74 71 45 55
No of cycles at first eye exam 2 11 15 3 3 3 6
No of cycles at last eye exam 3 13 24 8 5 4 7
Change in dosage yes

adjusted dose = lower dose due to the cutaneous side effects

 no no no no no no
BCVA RE 1.0 1.0 1.0 0.7 – 0.9 0.8 1.0 1.0
BCVA LE 1.0 1.0 1.0 0.7 – 0.9 0.7 1.0 1.0
Symptoms circle centrally blurred vision no blurred vision floaters in LE, blurred vision circle centrally no
Occurrence of symptoms after starting the therapy 1 week 1 week - 1 week 1 month 1 week -
Fluctuations of symptoms spontan. resolution no - different spectacles needed better after topical therapy spontan. resolution needs spectacles
OCT changes in the fovea elongatio of IZ SRF SRF SRF elongation of IZ in RE, SRF in LE SRF SRF
Extrafoveal SRF multiple bilateral multiple bilateral multiple bilateral multiple bilateral no no multiple bilateral
Other ocular findings - - - incipient senile cataract ou uveitis in LE; incipient cataract ou - dilatated conjuctival vessels in the RE
Language:
English
Publication timeframe:
4 times per year
Journal Subjects:
Medicine, Clinical Medicine, Internal Medicine, Haematology, Oncology, Radiology
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