Diagnostic Tests and Workup of Patient’s Vision Loss

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	MethylprednisoloneIV 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 fieldconstriction; opticdisc swelling; Left eye- vision remained nolight perception	Right Eye - subjectivevision improvement;reduced optic discswelling; followingsteroid treatment	Right Eye- declinedvisual 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 62RBC 2	WBC 69RBC 1	WBC 42RBC 1		WBC 7RBC 0
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

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