alexa Simultaneous Treatment of Severe Vemurafenib-induced Uv
ISSN: 2155-9570

Journal of Clinical & Experimental Ophthalmology
Open Access

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Case Report

Simultaneous Treatment of Severe Vemurafenib-induced Uveitis and Metastatic Melanoma

Moritz C Daniel1,2*, Sonja Heinzelmann1 and Thomas Neß1
1Eye Center - University Medical Center Freiburg, University of Freiburg, Killianstr. 5, 79106 Freiburg, Germany
2Moorfields Eye Hospital - Richard Desmond Children's Centre, Germany
3Peerless Street, London EC1V 9EZ, Great Britain, Germany
Corresponding Author : Moritz C Danie
Eye Center - University Medical Center Freiburg
Killianstr. 579106 Freiburg, Germany
Tel: +49 (0)761 270 41010 13
Fax: +49 (0)761 270 41271
E-mail: [email protected]
Received: January 06, 2016 Accepted: January 27, 2016 Published: January 29, 2016
Citation: Daniel MC, Heinzelmann S, Neß T (2016) Simultaneous Treatment of Severe Vemurafenib-induced Uveitis and Metastatic Melanoma. J Clin Exp Ophthalmol 7:513. doi:10.4172/2155-9570.1000513
Copyright: © 2016 Daniel MC, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Abstract

Background: Vemurafenib, a serine-threonine kinase inhibitor, has been used to treat unresectable metastatic melanoma since 2011. Ocular adverse events are reported to be seldom and to regress after the discontinuation of vemurafenib and therapy with topical steroids. However, this approach must be weighed against the potential progression of melanoma. We present alternative options in uveitis treatment enabling the continuation of vemurafenib therapy. Case report: We describe the clinical course of vemurafenib-induced uveitis in two patients initially presenting with macular oedema and scleritis. Both patients were treated successfully without discontinuing vemurafenib. Intraocular inflammation and macular oedema receded slowly after intraocular injection of 700 mg dexamethasone into the first patient's right eye. A moderate rise in intraocular pressure was controlled easily with topical antiglaucomatous treatment. Since the intraocular inflammation had not abated under topical steroids, dexamethasone was injected into the left eye also. The second patient presented with intraocular inflammation and severe scleritis in both eyes, and was treated systemically with 80 mg prednisolone p.o. per day. His ocular condition and visual acuity improved quickly. The macular oedema receded completely in both eyes. Conclusion: In patients with vemurafenib-induced uveitis, the progression of melanoma must always be weighed against the alleviation of ocular symptoms. We suggest a priori systemic or intravitreal steroid treatment with simultaneous anti-melanotic therapy. Intravitreal treatment should be considered in case of macular oedema. Systemic and topical steroid therapy requires slow tapering to prevent a relapse of ocular inflammation

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