Acute Bilateral Uveitis, Hypotony, and Cataracts Associated with Ipilimumab and Nivolumab Therapy: Optical Coherence Tomography Angiography Findings

Abstract

Immune checkpoint inhibitors are increasingly being used for the treatment of several malignancies. In rare cases, patients develop disabling ophthalmic side effects such as dry eyes, episcleritis, keratitis, uveitis, inflammatory orbitopathy, myasthenia gravis, macular edema, and serous retinal detachment. We present a case of acute bilateral anterior uveitis, prolonged hypotony, and cataracts following the use of dual therapy ipilimumab and nivolumab. Physicians should be aware of these immune-mediated ocular adverse events and should have a management plan to deal with these side effects that range from mild to vision threatening.

Ipilimumab-related uveitis and refractory hypotony with a flat chamber in a trabeculectomized eye with exfoliation glaucoma: A case report

“…Previous reports have shown that immune checkpoint inhibitors occasionally cause uveitis and hypotony. 8 , 9 , 10 It is thought that hypotony is caused by uveitis, trauma, medications, and ocular ischemia. 11 Our patient exhibited ipilimumab-related uveitis in both eyes, which probably led to hypotony.…”

Ocular Inflammation Induced by Immune Checkpoint Inhibitors

“…Most anterior uveitis were treated with topical treatment alone, with a positive outcome [ 16 , 19 , 22 , 25 , 26 , 27 , 38 , 41 , 44 , 45 , 48 , 52 , 59 , 63 , 102 ]. In the literature, uveitis recurrences have mainly been noted when patients resumed ICPI [ 17 , 61 ] sometimes with a different SUN anatomical classification.…”

Unilateral Posterior Uveitis in a Patient Receiving Nivolumab for Malignant Melanoma

“…Immunotherapies in the form of immune checkpoint inhibitors (ICIs) have been developed to treat many malignancies, including melanoma, and squamous cell carcinoma, amongst others [ 1 ]. Clinical trials have shown ICIs are efficacious, but patients report immune-related adverse effects (irAEs); at around 10-15% higher rate than patients receiving classic chemotherapy drugs.…”

“…Clinical trials have shown ICIs are efficacious, but patients report immune-related adverse effects (irAEs); at around 10-15% higher rate than patients receiving classic chemotherapy drugs. irAEs are mainly in the dermatological, gastrointestinal, hepatic, and endocrine systems [ 1 ]. However, 1% of patients may also manifest in the visual system.…”

“…However, 1% of patients may also manifest in the visual system. Unfortunately, patients with ocular irAEs are severely affected, presenting an outcome warranting further investigation [ 1 ]. We present a case of a 75-year-old woman with metastatic melanoma who suffered from unilateral uveitis due to nivolumab administration.…”