BILATERAL METASTATIC CUTANEOUS MELANOMA TO RETINA AND VITREOUS AFTER IPILIMUMAB TREATED WITH PARS PLANA VITRECTOMY AND RADIOTHERAPY.
OBJECTIVE
To report a patient with bilateral metastatic cutaneous melanoma to the retina and vitreous presenting as a right panuveitis.


METHODS
A 63-year-old woman with metastatic malignant cutaneous melanoma treated with ipilimumab and prolonged high-dose steroids presented with a right panuveitis and right blurred vision. Dilated fundus examination revealed bilateral, off-white, large, globular vitreous opacities and bilateral retinal lesions. These retinal lesions had a pale yellow appearance with a cuff of haemorrhage. The unpigmented appearance of the vitreous opacities raised the suspicion of candida endophthalmitis.


RESULTS
Bilateral, sequential pars plana vitrectomy with pathomorphologic examination of the vitreous specimen demonstrated metastatic melanoma. Ocular radiotherapy followed by cataract surgery resulted in the regression of retinal lesions in both eyes and no recurrence of the vitreous metastases.


CONCLUSIONS
The development of vitreous and retinal metastases despite a systemic response to ipilimumab identifies the challenge of immunotherapy in an immune privileged site. Treatment is challenging, and outcomes are variable. A local approach of bilateral pars plana vitrectomy, external beam radiotherapy, and subsequent bilateral cataract surgery provided an excellent visual result with no recurrence at 12 months.
Southampton Eye Unit, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
Sam
S
Kanavati
Cancer Sciences Unit and Southampton Experimental Cancer Medicine Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
Christian
C
Ottensmeier
Department of Histopathology, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
Vipul
V
Foria
Southampton Eye Unit, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
Radhika
R
Krishnan
D000074322:Antineoplastic Agents, Immunological / Q000627:therapeutic use; D005134:Eye Neoplasms / Q000556:secondary*; D005260:Female; D006801:Humans; D000074324:Ipilimumab / Q000627:therapeutic use; D008545:Melanoma / Q000556:secondary*; D008875:Middle Aged; D019572:Retinal Neoplasms / Q000556:secondary*; D012878:Skin Neoplasms / Q000473:pathology*; D014821:Vitrectomy; D014822:Vitreous Body / Q000473:pathology*
D000074322:Antineoplastic Agents, Immunological; D000074324:Ipilimumab