Bilateral Corneal Perforation in a Patient Under Anti-PD1 Therapy

Ramaekers, Anaïs; Aspeslagh, Sandrine; Brucker, Nele De; Mierlo, Camille Van; Tusscher, Marcel Ten; Schauwvlieghe, Pieter-Paul; Termote, Karolien

doi:10.1097/ico.0000000000002490

Cited by 14 publications

(8 citation statements)

References 13 publications

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“…There have only been a few similar reports of ocular toxicities, most involving corneal ulceration . One described bilateral corneal perforation in a patient taking pembrolizumab, and the other reported corneal ulceration associated with nivolimumab . Similar to the patient in this case report, these diagnoses were also made based on the association with immunotherapy and symptoms, along with pan-negative diagnostic evaluation .…”

Section: Discussionsupporting

confidence: 62%

Association of Conjunctival Ulceration With Pembrolizumab

Kuhar,

Bailey,

Aeum

2024

JAMA Ophthalmol

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Section: Discussionsupporting

confidence: 62%

Association of Conjunctival Ulceration With Pembrolizumab

Kuhar,

Bailey,

Aeum

2024

JAMA Ophthalmol

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“…A systematic review showed that the incidence of DED related to the use of ICIs ranges from 1.2% to 24.2% [ 199 ] The fact that these values vary widely, is consistent with our hypothesis that DED is not always reported consistently. Nevertheless, the impact on the quality of life of the patient can be important and severe DED can eventually progress to corneal perforation [ 159 , 168 ].…”

Section: Discussionmentioning

confidence: 99%

Ocular adverse events associated with immune checkpoint inhibitors, a scoping review

Martens

Schauwvlieghe

Madoe

et al. 2023

J Ophthal Inflamm Infect

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Introduction Immune checkpoint inhibitors (ICIs) have become an important part of the treatment of multiple cancers, especially for advanced melanoma and non-small cell lung cancer. Some tumors are capable of escaping immunosurveillance by stimulating checkpoints on T-cells. ICIs prevent activation of these checkpoints and thereby stimulate the immune system and indirectly the anti-tumor response. However, the use of ICIs is associated with various adverse events. Ocular side effects are rare but may have a major impact on the quality of life of the patient. Methods A comprehensive literature search of the medical databases Web of Science, Embase and PubMed was performed. Articles that provided a comprehensive description of a case report containing 1) cancer patient(s) treated with (a combination of) immune checkpoint inhibitors, and 2) assessed occurrence of ocular adverse events, were included. A total of 290 case reports were included. Results Melanoma (n = 179; 61.7%) and lung cancer (n = 56; 19.3%) were the most frequent reported malignancies. The primary used ICIs were nivolumab (n = 123; 42.5%) and ipilimumab (n = 116; 40.0%). Uveitis was most the common adverse event (n = 134; 46.2%) and mainly related to melanoma. Neuro-ophthalmic disorders, including myasthenia gravis and cranial nerve disorders, were the second most common adverse events (n = 71; 24.5%), mainly related to lung cancer. Adverse events affecting the orbit and the cornea were reported in 33 (11.4%) and 30 cases (10.3%) respectively. Adverse events concerning the retina were reported in 26 cases (9.0%). Conclusion The aim of this paper is to provide an overview of all reported ocular adverse events related to the use of ICIs. The insights retrieved from this review might contribute to a better understanding of the underlying mechanisms of these ocular adverse events. Particularly, the difference between actual immune-related adverse events and paraneoplastic syndromes might be relevant. These findings might be of great value in establishing guidelines on how to manage ocular adverse events related to ICIs.

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“…Dry eye and corneal perforation have also been associated with the down regulation of PD-L1 [69]. Downregulation of corneal PD-L1 amplifies dry eye-associated corneal inflammation and epitheliopathy by modulating the expression of chemokine gene transcripts, which facilitates T-cell infiltration into the cornea in dry eye disease [70].…”

Section: Examples Of Disruption Of Ocular Immune Privilegementioning

confidence: 99%

Ocular involvement in allergic drug reactions

Fernandez

Phillips

Saeed

2023

Current Opinion in Allergy &Amp; Clinical Immunology

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Purpose of review Many systemic medications have been observed to cause ocular toxicity. A subset of these reactions is thought to involve immunomodulation or a hypersensitivity reaction. As new medications are developed, ocular adverse effects are becoming increasingly prevalent. Herein we review immune-mediated drug reactions affecting they eye with special attention to the hypersensitivity mechanisms leading to ocular toxicity. Recent findings Recent work has focused on mechanisms and risk of immune-mediated ocular adverse drug reactions including genetic susceptibility and loss of ocular immune privilege. Summary Given the consequences of immune-mediated ocular adverse drug reactions, clinicians must be aware of these to facilitate early recognition and management. The prompt involvement of an ophthalmologist for diagnosis and management is often essential to preserve vision and avoid long-term morbidity.

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Bilateral Corneal Perforation in a Patient Under Anti-PD1 Therapy

Cited by 14 publications

References 13 publications

Association of Conjunctival Ulceration With Pembrolizumab

Association of Conjunctival Ulceration With Pembrolizumab

Ocular adverse events associated with immune checkpoint inhibitors, a scoping review

Ocular involvement in allergic drug reactions

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