重视肿瘤免疫治疗相关眼底并发症的诊断与治疗

Pay attention to the diagnosis and treatment of fundus complications related to tumor immunotherapy

肿瘤免疫治疗是通过干预机体免疫系统,恢复机体的抗肿瘤免疫反应,从而达到控制或清除肿瘤细胞的治疗效果。阻断程序性死亡受体-1/程序性死亡受体配体-1/细胞毒性T淋巴细胞相关抗原-4的免疫检查点抑制剂疗法是最常用的肿瘤免疫疗法之一,疗效好且应用广泛,但这些药物会引起葡萄膜炎、自身免疫性视网膜病变和巩膜炎等免疫相关的眼部并发症,其成为眼部炎症的一种新病因。眼科医师掌握这些疾病的临床特点有助于及时诊断,同时与肿瘤医师密切配合,根据患者原发肿瘤情况、生存预后、眼部免疫治疗相关不良反应严重程度、视力预后来综合判断,制定最优治疗方案,从而挽救患者的视力,提高生存质量。

Cancer immunotherapy refers to the therapeutic effect of controlling or eliminating tumor cells by interfering with the immune system to restore the anti-tumor immune response.Immune checkpoint inhibitor therapy that blocks programmed death-1/programmed cell death ligand-1/cytotoxic T lymphocyte-associated antigen 4 is one of the most commonly used tumor immunotherapies,with good efficacy and wide application.These drugs cause immune-related ocular complications such as uveitis,autoimmune retinopathy,and scleritis,which represent a new etiology of ocular inflammation.The ophthalmologist's grasp of the clinical characteristics of these diseases is helpful for timely diagnosis.At the same time,the ophthalmologist will work closely with the oncologist to make a comprehensive judgment based on the patient's primary tumor,survival prognosis,severity of adverse reactions related to ocular immunotherapy,and visual prognosis,and develop suitable therapeutic strategie,thereby saving the patients'vision and improving the quality of life.