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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
, 
Janja Ocvirk
Janja Ocvirk
 y 
Polona Jaki Mekjavic
Polona Jaki Mekjavic
   | 24 ene 2018
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Article Category: Research Article
Publicado en línea: 24 ene 2018
Páginas: 213 - 219
Recibido: 04 oct 2017
Aceptado: 20 nov 2017
DOI: https://doi.org/10.2478/raon-2018-0002
© 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
eISSN:
1581-3207
Idioma:
Inglés
Calendario de la edición:
4 veces al año
Temas de la revista:
Medicine, Clinical Medicine, Internal Medicine, Haematology, Oncology, Radiology
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