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Checkpoint inhibitor-induced uveitis: a case series

  • Inflammatory Disorders
  • Published:
Graefe's Archive for Clinical and Experimental Ophthalmology Aims and scope Submit manuscript

Abstract

Purpose

Checkpoint inhibitors are now a common treatment modality for metastatic cancer. In this manuscript, we describe the clinical features and management of autoimmune non-infectious uveitis induced by this class of drugs.

Methods

Seven patients undergoing checkpoint inhibitor treatment for metastatic cancer from uveitis practices at three tertiary referral centers.

Results

All seven patients developed various severities of ocular inflammatory disease while taking checkpoint inhibitors for metastatic disease.

Conclusions

Checkpoint inhibitors may induce autoimmune uveitis. Ocular complaints should prompt an early evaluation by an ophthalmologist.

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Funding

Research to Prevent Blindness, Inc., New York, NY, provided an unrestricted grant to the to the Department of Ophthalmology & Visual Sciences at the University of Utah and to the Department of Ophthalmology, University of Colorado. The sponsor had no role in the design of this study.

Author information

Authors and Affiliations

  1. Department of Ophthalmology, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, 84112, USA

    Christopher D. Conrady, Marissa Larochelle & Akbar Shakoor

  2. Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, 80045, USA

    Paula Pecen & Alan Palestine

  3. Department of Ophthalmology, University of Kansas School of Medicine, Kansas City, KS, 66160, USA

    Ajay Singh

Authors
  1. Christopher D. Conrady
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  2. Marissa Larochelle
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  3. Paula Pecen
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  4. Alan Palestine
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  5. Akbar Shakoor
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  6. Ajay Singh
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Corresponding author

Correspondence to Ajay Singh.

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Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (institutional review board) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this retrospective study formal consent is not required.

Electronic supplementary material

Supplemental Figure 1

Nivolumab-associated VKH-like syndrome: Case 5. A 52-year-old man with metastatic melanoma being treated with nivolumab, and who had recently discontinued ipilimumab per treatment protocol, developed a cloud in the vision of his right eye, whitening of his eyebrows, several patches of skin depigmentation, and hearing loss. a–b Fundus photographs showed optic disc edema, OD > OS and loss of foveal light reflex OD. c–d OCT identified subretinal fluid in the right eye (c) and normal retinal architecture of the left (d), with resolution of subretinal fluid with oral prednisone (e). (GIF 167 kb)

High Resolution (TIFF 10945 kb)

Supplemental Figure 2

Nivolumab-associated multifocal choroiditis: Case 6. A 57-year-old man with metastatic non-small cell adenocarcinoma of the lung that was being treated with nivolumab infusions developed conjunctival injection, decreased vision, and photosensitivity OU approximately 9 months after starting therapy. a–b At presentation, the patient had anterior uveitis, subretinal fluid extending from the nerve, an irregular choroid, and disc leakage and patchy hyperfluorescence of the posterior pole. c–d Enhanced-depth imaging OCT OD revealed a thickened choroid, indicated by yellow arrows, and repeat OCT showed subfoveal subretinal fluid. e–f Fundus photographs several months after initial presentation demonstrated depigmented chorioretinal lesions in both eyes despite a negative HLA-A29. This was consistent with a multifocal choroiditis that was not evident at presentation (e–g), but showed resolution of choroidal thickening, indicated by the yellow arrows. (GIF 365 kb)

High Resolution (TIFF 28818 kb)

Supplemental Figure 3

Pembrolizumab-associated iridocyclitis: Case 7. A 62-year-old man with metastatic melanoma treated with dabrafenib and trametinib discontinued both medications 1 week prior to presentation due to blurry vision with fevers, chills, and rash. Macular edema was noted on exam and confirmed by OCT, and improved with local steroids. After restarting his immunostimulatory medications, he developed iritis, keratic precipitates, AC cell, and macular edema controlled with local therapy. Four months after initial presentation, the patient changed treatment from dabrafenib and trametinib to pembrolizumab, but continued to have intermittent episodes of iridocyclitis and cystoid macular edema (above) controlled with local therapy. (GIF 104 kb)

High Resolution (TIFF 14034 kb)

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Conrady, C.D., Larochelle, M., Pecen, P. et al. Checkpoint inhibitor-induced uveitis: a case series. Graefes Arch Clin Exp Ophthalmol 256, 187–191 (2018). https://doi.org/10.1007/s00417-017-3835-2

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  • DOI: https://doi.org/10.1007/s00417-017-3835-2

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