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Table 1 Diagnostic Tests and Workup of Patient’s Vision Loss

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
  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     23   
Cell count   WBC 62
WBC 69
WBC 42
  WBC 7
Protein (normal 15-45)   104 96 51   32
Glucose (normal 40-70)   55 52 86   112
Infectious work-up    Fungal Cx neg; AFB stain neg; Crytpo Ag neg; HSV PCR neg; RPR neg; Lyme neg; CMV neg; VZV; neg; Bartonella neg Cx neg   Cx neg
Cytology    Negative for malignancy Negative for malignancy   Negative for malignancy
  1. Abbreviations: IV intravenous; BID twice a day, AFB acid fast bacili, CMV cytomegalovirus, Crypto - cryptococcus; Cx culture, HSV herpes simplex virus; neg - negative; RPR rapid plasma reagin (syphilis), VZV varicella zoster virus