Usefulness of intravitreal dexamethasone implant in the management of «Vogt-Koyanagi-Harada-like syndrome» secondary to map kinase pathway inhibition

R Campos Polo; D García Guisado; C Rubio Sánchez; N T Márquez Ivacevich

doi:10.1016/j.oftal.2020.05.014

Usefulness of intravitreal dexamethasone implant in the management of «Vogt-Koyanagi-Harada-like syndrome» secondary to map kinase pathway inhibition

Arch Soc Esp Oftalmol (Engl Ed). 2020 Oct;95(10):501-506. doi: 10.1016/j.oftal.2020.05.014. Epub 2020 Jun 24.

[Article in English, Spanish]

Authors

R Campos Polo¹, D García Guisado², C Rubio Sánchez³, N T Márquez Ivacevich⁴

Affiliations

¹ Hospital Don Benito-Villanueva, Don Benito, Badajoz, España. Electronic address: rafacampospolo@hotmail.com.
² Hospital Don Benito-Villanueva, Don Benito, Badajoz, España.
³ Hospital Virgen del Puerto, Plasencia, Cáceres, España.
⁴ Hospital Campo Aarañuelo, Navalmoral de la Mata, Cáceres, España.

PMID: 32593600
DOI: 10.1016/j.oftal.2020.05.014

Abstract

The case is presented of a 58-year-old woman with a personal history of metastatic melanoma under treatment with trametinib and dabrafenib, as well as a decrease in bilateral visual acuity. On examination, it was observed that she had an anterior uveitis, vitritis, serous retinal detachment, vasculitis and disc oedema in both eyes. She was diagnosed with a Vogt-Koyanagi-Harada-like syndrome secondary to MAP kinase pathway inhibition. In addition to the withdrawal of the oncology drugs, systemic and topical corticosteroids were prescribed, but this treatment only achieved a partial improvement of the disease when biological therapy was re-introduced. Therefore, a bilateral intravitreal dexamethasone implant was added, which led to a favourable progression in her symptomatology, as well as in the findings of complementary tests. Intraocular inflammation is a complication described after treatment with trametinib and dabrafenib. An accurate diagnosis, added to corticosteroid treatment, systemic and intravitreal, led us to obtain optimal results.

Keywords: Dabrafenib; Dexamethasone implant; Implante de dexametasona; MAP kinase pathway; Síndrome de Vogt-Koyanagi-Harada-like; Trametinib; Vogt-Koyanagi-Harada-like syndrome; Vía MAP quinasa.