Bilateral Paracentral Corneal Melting and Left-Eye Perforation under Tobemstomig Novel Treatment
Introduction: We present a rare occurrence of bilateral corneal melting and a left-eye corneal perforation in an oncologic patient undergoing a new biological therapy. Case Presentation: A 63-year-old male with a two-day history of a painful left red eye and bilateral visual impairment was enrolled...
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| Format: | Article |
| Language: | English |
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Karger Publishers
2024-01-01
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| Series: | Case Reports in Ophthalmology |
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| Online Access: | https://beta.karger.com/Article/FullText/536103 |
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| author | Pablo González de los Mártires Gonzalo Guerrero Pérez Nerea Gangoitia Gorrotxategi Iñigo Salmerón Garmendia Leire Olazaran Gamboa Ana Jiménez Alonso Lara Berástegui Arbeloa |
| author_facet | Pablo González de los Mártires Gonzalo Guerrero Pérez Nerea Gangoitia Gorrotxategi Iñigo Salmerón Garmendia Leire Olazaran Gamboa Ana Jiménez Alonso Lara Berástegui Arbeloa |
| author_sort | Pablo González de los Mártires |
| collection | DOAJ |
| description | Introduction: We present a rare occurrence of bilateral corneal melting and a left-eye corneal perforation in an oncologic patient undergoing a new biological therapy. Case Presentation: A 63-year-old male with a two-day history of a painful left red eye and bilateral visual impairment was enrolled in a multicenter phase-II study comparing tobemstomig/RO7247669, a PD1-LAG3 bispecific antibody, with nivolumab. Clinical examination revealed a bilateral central corneal thinning, and corneal OCT imaging indicated a significant stromal thinning of 124 μm in the right eye and a central corneal perforation of 286 μm in the left eye. Subsequently, the patient underwent surgical intervention involving an autologous partial scleral patch with a Gundersen conjunctival flap in the left eye, alongside a comprehensive topical and systemic treatment regimen. Due to this immune-related adverse event, the patient was excluded from the clinical trial subsequently later revealing he had been on the bispecific treatment. Conclusion: While immune checkpoint inhibitors hold promise in oncology, they can lead to ocular surface issues, including dry-eye keratitis and, in severe cases, anterior segment thinning culminating in corneal perforation. Timely withdrawal of immunotherapy, coupled with multi-level treatment involving anti-inflammatory and corneal healing approaches, is crucial. In cases of corneal perforation, surgical intervention such as cyanoacrylate application or tectonic surgery becomes imperative. |
| first_indexed | 2024-03-07T19:39:08Z |
| format | Article |
| id | doaj.art-ec9d061646d242db937b18497bd2e239 |
| institution | Directory Open Access Journal |
| issn | 1663-2699 |
| language | English |
| last_indexed | 2024-03-07T19:39:08Z |
| publishDate | 2024-01-01 |
| publisher | Karger Publishers |
| record_format | Article |
| series | Case Reports in Ophthalmology |
| spelling | doaj.art-ec9d061646d242db937b18497bd2e2392024-02-29T07:06:19ZengKarger PublishersCase Reports in Ophthalmology1663-26992024-01-0115110811410.1159/000536103536103Bilateral Paracentral Corneal Melting and Left-Eye Perforation under Tobemstomig Novel TreatmentPablo González de los Mártires0Gonzalo Guerrero Pérez1Nerea Gangoitia Gorrotxategi2Iñigo Salmerón Garmendia3Leire Olazaran Gamboa4Ana Jiménez Alonso5Lara Berástegui Arbeloa6Ophthalmology Department, Hospital Universitario de Navarra, Pamplona, SpainOphthalmology Department, Hospital Universitario de Navarra, Pamplona, SpainOphthalmology Department, Hospital Universitario de Navarra, Pamplona, SpainOphthalmology Department, Hospital Universitario de Navarra, Pamplona, SpainOphthalmology Department, Hospital Universitario de Navarra, Pamplona, SpainOphthalmology Department, Hospital Universitario de Navarra, Pamplona, SpainOphthalmology Department, Hospital Universitario de Navarra, Pamplona, SpainIntroduction: We present a rare occurrence of bilateral corneal melting and a left-eye corneal perforation in an oncologic patient undergoing a new biological therapy. Case Presentation: A 63-year-old male with a two-day history of a painful left red eye and bilateral visual impairment was enrolled in a multicenter phase-II study comparing tobemstomig/RO7247669, a PD1-LAG3 bispecific antibody, with nivolumab. Clinical examination revealed a bilateral central corneal thinning, and corneal OCT imaging indicated a significant stromal thinning of 124 μm in the right eye and a central corneal perforation of 286 μm in the left eye. Subsequently, the patient underwent surgical intervention involving an autologous partial scleral patch with a Gundersen conjunctival flap in the left eye, alongside a comprehensive topical and systemic treatment regimen. Due to this immune-related adverse event, the patient was excluded from the clinical trial subsequently later revealing he had been on the bispecific treatment. Conclusion: While immune checkpoint inhibitors hold promise in oncology, they can lead to ocular surface issues, including dry-eye keratitis and, in severe cases, anterior segment thinning culminating in corneal perforation. Timely withdrawal of immunotherapy, coupled with multi-level treatment involving anti-inflammatory and corneal healing approaches, is crucial. In cases of corneal perforation, surgical intervention such as cyanoacrylate application or tectonic surgery becomes imperative.https://beta.karger.com/Article/FullText/536103anti-pd-1 and anti-lag-3 treatmentcase reportcorneal inflammation and perforationimmune checkpoint inhibitorsimmune-related adverse events |
| spellingShingle | Pablo González de los Mártires Gonzalo Guerrero Pérez Nerea Gangoitia Gorrotxategi Iñigo Salmerón Garmendia Leire Olazaran Gamboa Ana Jiménez Alonso Lara Berástegui Arbeloa Bilateral Paracentral Corneal Melting and Left-Eye Perforation under Tobemstomig Novel Treatment Case Reports in Ophthalmology anti-pd-1 and anti-lag-3 treatment case report corneal inflammation and perforation immune checkpoint inhibitors immune-related adverse events |
| title | Bilateral Paracentral Corneal Melting and Left-Eye Perforation under Tobemstomig Novel Treatment |
| title_full | Bilateral Paracentral Corneal Melting and Left-Eye Perforation under Tobemstomig Novel Treatment |
| title_fullStr | Bilateral Paracentral Corneal Melting and Left-Eye Perforation under Tobemstomig Novel Treatment |
| title_full_unstemmed | Bilateral Paracentral Corneal Melting and Left-Eye Perforation under Tobemstomig Novel Treatment |
| title_short | Bilateral Paracentral Corneal Melting and Left-Eye Perforation under Tobemstomig Novel Treatment |
| title_sort | bilateral paracentral corneal melting and left eye perforation under tobemstomig novel treatment |
| topic | anti-pd-1 and anti-lag-3 treatment case report corneal inflammation and perforation immune checkpoint inhibitors immune-related adverse events |
| url | https://beta.karger.com/Article/FullText/536103 |
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