case_images: PMC11018330_01
case_images: a Fundus photograph showed atrophic macula due to previous nAMD treated with multiple anti-vascular endothelial growth factor (anti-VEGF) injections in the right eye, and no pathognomonic sign was found except floater in the left eye. b Fundus AF revealed large C-shaped hypo-AF with enhanced AF at the margins in both eyes (black arrowheads).
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case_images: F1
case_images: The right fundus photograph revealed an atrophic macula attributable to the nAMD, and there was no specific finding in the left eye other than mild pigmentary changes (Fig. 1a). On fundus autofluorescence (AF) examination, photoreceptor injuries evidenced by broad C-shaped hypo-AFs with hyperfluorescent margins explained the symptoms in both eyes (Fig. 1b).
case_images: a Before the durvalumab therapy, OCT showed age-related macular degeneration (AMD)-related macular changes in the right eye and normal findings on the left eye. b One month after starting durvalumab, OCT showed mild outer layer atrophy and ellipsoid disruption at nasal retina and temporal to the disc on the left eye. c After 6 months of follow-up, OCT showed bilateral outer retinal layer atrophy and progressive loss of ellipsoid line at nasal retina and temporal to the disc in the left eye sparing the fovea corresponding to patient's complaints and visual field examination results.
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case_images: F2
case_images: Optical coherence tomography (OCT) revealed loss of the peripapillary retinal ellipsoid zones of the left eye, consistent with a visual field defect (Fig. 2, 3).
case_images: a Static perimetry of the patient showed central scotoma due to previously treated nAMD in the right eye and mid-peripheral C-shaped scotomas at bilateral visual fields. b Four months following visual field examination after stopping durvalumab represented minimal improvement of mid-peripheral scotomas. c Six months after ceasing the medication, progressive mid-peripheral scotomas were presented in the left eye. d Nine months after quitting medication, static perimetry showed slightly decreased scotomas in the left eye.
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case_images: F3
case_images: Optical coherence tomography (OCT) revealed loss of the peripapillary retinal ellipsoid zones of the left eye, consistent with a visual field defect (Fig. 2, 3). Four months after subtenon triamcinolone administration and durvalumab cessation, OCT revealed that the ellipsoid zone near the nasal retina had partially recovered in the left eye (Fig. 3b), and a visual field test revealed a slight decrease in the scotoma sizes of both eyes, associated with symptom improvement (Fig. 4b). Subtenon injections of 4 mg triamcinolone were repeated for both eyes (Fig. 3c, 4c). However, the malignancy worsened, and the patient was unable to visit the outpatient clinic for 5 months (Fig. 3d, 4d).
case_images: a After 11 months treated with durvalumab, OCT showed progressive ellipsoid disruption in both eyes. b After 4 months of cessation of the medication and treatment with subtenon triamcinolone injection, ellipsoid line at nasal retina was not changed definitely in the left eye. c Six months after ceasing the medication, disruption of ellipsoid line was recurred in the left eye and treated with second subtenon triamcinolone injection. d After 3 months for second injection, OCT showed no progression of outer retinal atrophy.
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case_images: F4
case_images: During close follow-up, the symptoms worsened, and OCT revealed progressive photoreceptor atrophy approaching the fovea of the left eye (Fig. 4) and enlargement of the bilateral temporal scotomas on perimetric examinations (Fig. 3a). Subtenon injections of 4 mg triamcinolone were repeated for both eyes (Fig. 3c, 4c). However, the malignancy worsened, and the patient was unable to visit the outpatient clinic for 5 months (Fig. 3d, 4d).
case_images: a, b International Society for Clinical Electrophysiology of Vision (ISCEV) protocol using monopolar electrode electroretinograms (ERGs) of patient at time of recognition of bilateral scotoma and 11 months after durvalumab. The results of ERG illustrated dysfunction of cone and rod cell in the right eye and dysfunction of cone cell in the left eye.
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case_images: F5
case_images: Electroretinograms revealed cone and rod cell dysfunctions of the right eye and cone cell dysfunction of the left eye (Fig. 5).
case_images: Examinations after administration of nivolumab. a Fundus AF shows definite large C-shaped hypo-AF in both eyes. b OCT represents totally atrophic retina in the right eye, progressive loss of ellipsoid line except fovea in the left eye. c Static perimetry reveals total scotomas in both eyes.
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case_images: F6
case_images: Fundus AF revealed increased hypo-AF at the sites of the earlier C-shaped lesions (Fig. 6).