Steroid implants might benefit melanoma-associated retinopathy

This paper reports the first case of melanoma-associated retinopathy (MAR) to be managed using intravitreal fluocinolone acetonide implants.

Study design

The patient was a 73-year-old woman with metastatic cutaneous melanoma in remission who developed MAR. She was treated with bilateral fluocinolone acetonide intravitreal implants (Iluvien) and did not receive systemic immunosuppression. She was followed for 3 years. The main measures included fundus imaging, autofluorescence, OCT, visual field and full-field electroretinography (ERG).

Outcomes

Within 1 week of treatment, the patient’s visual acuity improved from 20/80 and 20/40 to 20/20 OU. Visual symptoms and visual fields both showed improvement. Electroretinography revealed partial recovery of abnormalities in the right eye, suggesting repair of inner retinal ON-bipolar cell function. Although the left eye did not show changes at 8 months, the ERG found improvement at 2 years.

Three years later, the macular function and automated perimetry showed improvement and vision remained at 20/20. Bilateral cataracts developed approximately 2 years after injection; there was no IOP elevation.

Limitations

This report only describes a single case.

Clinical significance

This paper describes a patient with MAR who had improvement in retinal function and symptoms with fluocinolone implants. Further work should be performed to see if local therapy could treat the disorder without systemic immunosuppression.