Zeitschrift für klinische und experimentelle Ophthalmologie
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Simultaneous Treatment of Severe Vemurafenib-induced Uveitis and Metastatic Melanoma

Moritz C Daniel, Sonja Heinzelmann and Thomas Neß

Background: Vemurafenib, a serine-threonine kinase inhibitor, has been used to treat unresectable metastatic melanoma since 2011. Ocular adverse events are reported to be seldom and to regress after the discontinuation of vemurafenib and therapy with topical steroids. However, this approach must be weighed against the potential progression of melanoma. We present alternative options in uveitis treatment enabling the continuation of vemurafenib therapy.
Case report: We describe the clinical course of vemurafenib-induced uveitis in two patients initially presenting with macular oedema and scleritis. Both patients were treated successfully without discontinuing vemurafenib. Intraocular inflammation and macular oedema receded slowly after intraocular injection of 700 mg dexamethasone into the first patient's right eye. A moderate rise in intraocular pressure was controlled easily with topical antiglaucomatous treatment. Since the intraocular inflammation had not abated under topical steroids, dexamethasone was injected into the left eye also. The second patient presented with intraocular inflammation and severe scleritis in both eyes, and was treated systemically with 80 mg prednisolone p.o. per day. His ocular condition and visual acuity improved quickly. The macular oedema receded completely in both eyes.
Conclusion: In patients with vemurafenib-induced uveitis, the progression of melanoma must always be weighed against the alleviation of ocular symptoms. We suggest a priori systemic or intravitreal steroid treatment with simultaneous anti-melanotic therapy. Intravitreal treatment should be considered in case of macular oedema. Systemic and topical steroid therapy requires slow tapering to prevent a relapse of ocular inflammation