Clinical and Experimental Ophthalmology最新文献

Uveal melanoma is a rare malignancy arising from uveal tract melanocytes. Definitive treatment options for primary disease include plaque brachytherapy, proton beam radiotherapy and enucleation, which provide high rates of local control, but are associated with vision impairment, reduced quality of life and unsatisfactorily high rates of metastatic relapse. In the metastatic setting, average life expectancy remains less than 2 years, despite the availability of immune checkpoint inhibitors and the more recent arrival of the T cell-engaging agent, tebentafusp. Here, we provide an update regarding the current treatment of uveal melanoma, and discuss the potential roles of novel targeted therapies, immunotherapy and neoadjuvant therapy in shaping future management.

This review provides an updated overview of the contemporary management of malignant eyelid tumours, focusing on evidence-based advances in both surgical and immunotherapeutic approaches. Eyelid malignancies represent a significant health burden, particularly in Australia and New Zealand where skin cancer rates are the highest globally. The article details the epidemiology, clinical presentation, diagnosis, and risk stratification for the five most common eyelid cancers: basal cell carcinoma, squamous cell carcinoma, sebaceous gland carcinoma, melanoma, and Merkel cell carcinoma. Current best practises emphasise microscopically controlled surgical excision as the mainstay of curative therapy, with excision margins tailored according to tumour and histology type. Mohs micrographic surgery and peripheral and deep margin assessment techniques are highlighted for improved local control and eyelid preservation. The review discusses the expanding role of immuno- and targeted therapies such as checkpoint inhibitors including program cell death (PD-1) and programmed cell death ligand (PD-L1) inhibitors, as well as targeted hedgehog inhibitors for unresectable and metastatic disease in melanoma, Merkel cell carcinoma, and advanced squamous cell carcinoma, demonstrating enhanced progression-free survival and durable responses. Management algorithms are increasingly multidisciplinary, integrating ophthalmology, dermatology, oncology, pathology, and reconstructive surgery. Ongoing challenges include timely detection, management of adverse effects, and the risk of recurrence and metastasis, necessitating long-term surveillance and individualised care.

Systemic anti-cancer treatment has evolved rapidly with the introduction of immunotherapy and targeted therapies, substantially improving survival across a broad spectrum of malignancies. However, as their use expands, ophthalmic toxicities are increasingly recognised as clinically significant adverse effects. This review outlines the pathophysiology, clinical spectrum and management strategies for ophthalmic adverse events linked to immune checkpoint inhibitors, MEK, BRAF, FGFR, ERK, EGFR, HER2, BTK, FLT-3, Bcr-Abl, ALK inhibitors and antibody-drug conjugates.

Background: Intraocular inflammation (IOI) is a rare but potentially sight-threatening complication that can occur after intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections. This adverse event has been under scrutiny in recent years due to an increased incidence, particularly with some of the newer anti-VEGF agents, such as Brolucizumab. Faricimab is a new anti-VEGF medication that has been approved by the United States Food and Drug Administration. As it is relatively new on the market, long-term safety data is still being collected.

Methods: This is a retrospective case series of 8 eyes in 5 patients with IOI that occurred after faricimab intravitreal injections.

Results: All patients were diagnosed with significant uveitis with anterior vitreous involvement and 4 out of the 5 patients presented subacutely with high intraocular pressure while the remaining patient presented acutely within 4 days following IVT with normal intraocular pressure. The patients received, on average, 4.875 faricimab injections prior to development of IOI and the inflammation resolved in all patients following cessation of faricimab injections and initiation of oral and topical non-steroidal anti-inflammatory agents and topical steroids.

Conclusion: Non-infectious hypertensive uveitis can occur subacutely after intravitreal faricimab injections. It is imperative that intraocular pressure is promptly managed to reduce the risk of permanent glaucomatous damage. As all our patients presented with anterior vitreous involvement, it is also practical that such cases of IOI are not mistaken for infectious exogenous endophthalmitis to avoid unnecessary treatment with intravitreal antibiotics and surgery.