From: Acute visual loss after ipilimumab treatment for metastatic melanoma
Time after initial ipilimumab treatment | Four months | Five months | Five and a half months | Six months | Fifteen months | |
---|---|---|---|---|---|---|
Steriod Dosing/immunosuppression | Prednisone 40 mg with taper to 20 mg |  | Methyprednisolone IV 1 gram x 3 days, then prednisone 40 mg | Methyprednisolone IV 1 gram x 5 days, then prednisone 100 mg daily, tapered to 80 mg daily | Methylprednisolone IV 1 gram daily x 10 days, then prednisone 100 mg daily, mycophenolate mofetil 1000 mg BID | Mycophenolate mofetil 1000 mg BID, slow prednisone taper |
Ophthalmologic Exam | Left Eye -No light perception Vision; Left afferent pupillary defect; Optic nerve swelling; retinal whitening | Right Eye- visual acuity 20/50; decreased color vision; visual field constriction; optic disc swelling; Left eye - vision remained no light perception | Right Eye - subjective vision improvement; reduced optic disc swelling; following steroid treatment | Right Eye- declined visual acuity | Â | Right Eye - visual acuity 20/20; resolved optic disc swelling; Left Eye -no light perception; atrophic optic nerve |
Magnetic Resonance Imaging | Unremarkable; No metastases | Unremarkable |  | Circumferential enhancement of intraorbital optic nerves, right > > left | Negative for brain metastases |  |
Lumbar Puncture | ||||||
Opening pressure | Â | Â | Â | 23 | Â | Â |
Cell count | Â | WBC 62 RBC 2 | WBC 69 RBC 1 | WBC 42 RBC 1 | Â | WBC 7 RBC 0 |
Protein (normal 15-45) | Â | 104 | 96 | 51 | Â | 32 |
Glucose (normal 40-70) | Â | 55 | 52 | 86 | Â | 112 |
Infectious work-up | Â | Â | Fungal Cx neg; AFB stain neg; Crytpo Ag neg; HSV PCR neg; RPR neg; Lyme neg; CMV neg; VZV; neg; Bartonella neg | Cx neg | Â | Cx neg |
Cytology | Â | Â | Negative for malignancy | Negative for malignancy | Â | Negative for malignancy |