Neuro-ophthalmic Complications of Immune Checkpoint Inhibitors: A Systematic Review.

IF 3.1 Q1 OPHTHALMOLOGY Eye and Brain Pub Date : 2020-11-03 eCollection Date: 2020-01-01 DOI:10.2147/EB.S277760

Caberry W Yu, Matthew Yau, Natalie Mezey, Ishraq Joarder, Jonathan A Micieli

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Abstract

Objective: Immune checkpoint inhibitors (ICIs) are novel cancer therapies that may be associated with immune-related adverse events (IRAEs) and come to the attention of neuro-ophthalmologists. This systematic review aims to synthesize the reported ICI-associated IRAEs relevant to neuro-ophthalmologists to help in the diagnosis and management of these conditions.

Methods: A systematic review of the literature indexed by MEDLINE, Embase, CENTRAL, and Web of Science databases was searched from inception to May 2020. Reporting followed the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. Primary studies on ICIs and neuro-ophthalmic complications were included. Outcomes included number of cases and incidence of neuro-ophthalmic IRAEs.

Results: Neuro-ophthalmic complications of ICIs occurred in 0.46% of patients undergoing ICI and may affect the afferent and efferent visual systems. Afferent complications include optic neuritis (12.8%), neuroretinitis (0.9%), and giant cell arteritis (3.7%). Efferent complications include myasthenia gravis (MG) (45.0%), thyroid-like eye disease (11.9%), orbital myositis (13.8%), general myositis with ptosis (7.3%), internuclear ophthalmoplegia (0.9%), opsoclonus-myoclonus-ataxia syndrome (0.9%), and oculomotor nerve palsy (0.9%). Pembrolizumab was the most common causative agent for neuro-ophthalmic complications (32.1%). Mortality was highest for MG (19.8%). Most patients (79.8%) experienced improvement or complete resolution of neuro-ophthalmic symptoms due to cessation of ICI and immunosuppression with systemic corticosteroids.

Conclusion: While incidence of neuro-ophthalmic IRAEs is low, clinicians involved in the care of cancer patients must be aware of their presentation to facilitate prompt recognition and management. Collaboration between oncology and neuro-ophthalmology teams is required to effectively manage patients and reduce morbidity and mortality.

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免疫检查点抑制剂的神经眼科并发症：系统综述。

目的：免疫检查点抑制剂（ICIs）是一种新型癌症疗法，可能与免疫相关不良事件（IRAEs）有关，并引起神经眼科医生的注意。本系统综述旨在总结与神经眼科医生相关的 ICI 相关 IRAE 报告，以帮助诊断和管理这些病症：方法：对 MEDLINE、Embase、CENTRAL 和 Web of Science 等数据库收录的文献进行了系统性检索。报告遵循《系统综述和荟萃分析首选报告项目》（PRISMA）指南。纳入了有关 ICIs 和神经眼科并发症的主要研究。结果包括病例数和神经眼科 IRAE 的发生率：结果：接受 ICI 的患者中有 0.46% 出现了 ICI 神经眼科并发症，这些并发症可能会影响传入和传出视觉系统。传入并发症包括视神经炎（12.8%）、神经视网膜炎（0.9%）和巨细胞动脉炎（3.7%）。传出并发症包括重症肌无力（MG）（45.0%）、甲状腺样眼病（11.9%）、眼眶肌炎（13.8%）、伴有上睑下垂的全身肌炎（7.3%）、核间性眼肌麻痹（0.9%）、肌阵挛-肌阵挛-共济失调综合征（0.9%）和眼运动神经麻痹（0.9%）。Pembrolizumab是神经眼科并发症最常见的致病因子（32.1%）。MG的死亡率最高（19.8%）。大多数患者（79.8%）在停止使用ICI和全身皮质类固醇免疫抑制后，神经眼科症状得到改善或完全缓解：结论：虽然神经眼科 IRAE 的发病率较低，但参与癌症患者护理的临床医生必须了解其表现形式，以便及时识别和处理。肿瘤科和神经眼科团队必须通力合作，才能有效管理患者，降低发病率和死亡率。

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来源期刊

Eye and Brain OPHTHALMOLOGY-

CiteScore

7.90

自引率

2.30%

发文量

审稿时长

16 weeks

期刊介绍： Eye and Brain is an international, peer-reviewed, open access journal focusing on basic research, clinical findings, and expert reviews in the field of visual science and neuro-ophthalmology. The journal’s unique focus is the link between two well-known visual centres, the eye and the brain, with an emphasis on the importance of such connections. All aspects of clinical and especially basic research on the visual system are addressed within the journal as well as significant future directions in vision research and therapeutic measures. This unique journal focuses on neurological aspects of vision – both physiological and pathological. The scope of the journal spans from the cornea to the associational visual cortex and all the visual centers in between. Topics range from basic biological mechanisms to therapeutic treatment, from simple organisms to humans, and utilizing techniques from molecular biology to behavior. The journal especially welcomes primary research articles or review papers that make the connection between the eye and the brain. Specific areas covered in the journal include: Physiology and pathophysiology of visual centers, Eye movement disorders and strabismus, Cellular, biochemical, and molecular features of the visual system, Structural and functional organization of the eye and of the visual cortex, Metabolic demands of the visual system, Diseases and disorders with neuro-ophthalmic manifestations, Clinical and experimental neuro-ophthalmology and visual system pathologies, Epidemiological studies.