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Inicio Archivos de la Sociedad Española de Oftalmología (English Edition) Usefulness of intravitreal dexamethasone implant in the management of «Vogt-Koy...
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Vol. 95. Issue 10.
Pages 501-506 (October 2020)
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Vol. 95. Issue 10.
Pages 501-506 (October 2020)
Short communication
Usefulness of intravitreal dexamethasone implant in the management of «Vogt-Koyanagi-Harada-like syndrome» secondary to map kinase pathway inhibition
Eficacia del implante de dexametasona intravítreo en el manejo del «síndrome de Vogt-Koyanagi-Harada-like» secundario a la inhibición de la vía MAP quinasa
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R. Campos Poloa,
Corresponding author
rafacampospolo@hotmail.com

Corresponding author.
, D. García Guisadoa, C. Rubio Sánchezb, N.T. Márquez Ivacevichc
a Hospital Don Benito-Villanueva, Don Benito, Badajoz, Spain
b Hospital Virgen del Puerto, Plasencia, Cáceres, Spain
c Hospital Campo Aarañuelo, Navalmoral de la Mata, Cáceres, Spain
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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 disk edema 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 favorable 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:
Trametinib
Dabrafenib
Vogt-Koyanagi-Harada-like syndrome
MAP kinase pathway
Dexamethasone implant
Resumen

Mujer de 58 años, con antecedentes personales de melanoma metastásico en tratamiento con trametinib y dabrafenib, que presentaba disminución de agudeza visual bilateral. En la exploración se podía observar uveítis anterior, vitritis, desprendimiento de retina seroso, vasculitis y edema de disco en ambos ojos; se la diagnosticó de síndrome de Vogt-Koyanagi-Harada-like secundario a inhibición de la vía MAP quinasa. Además de la retirada de los fármacos oncológicos, se pautaron corticoides sistémicos y tópicos, pero este tratamiento consiguió solo una mejoría parcial del cuadro cuando se reintrodujo la terapia biológica; se añadió, por tanto, un implante de dexametasona intravítreo bilateral que consiguió una evolución favorable en su sintomatología y en los hallazgos de las pruebas complementarias.

La inflamación intraocular es una complicación descrita tras el tratamiento con trametinib y dabrafenib. Un diagnóstico preciso unido al tratamiento corticoideo, tanto sistémico como intravítreo, nos llevó a obtener óptimos resultados.

Palabras clave:
Trametinib
Dabrafenib
Síndrome de Vogt-Koyanagi-Harada-like
Vía MAP quinasa
Implante de dexametasona

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