Table 1
Published cases reporting uveitis secondary to durvalumab (PD-L1 inhibitor) treatment
| Author, year | Number of cases reported | Indication | Ocular inflammation specification (% eyes) | Treatment | Discontinuing immune checkpoint inhibitor |
|---|---|---|---|---|---|
| Dow et al. 20206 | 3 | n/a | Anterior uveitis 80% Posterior uveitis 20% | Local corticosteroid Systemic corticosteroid | No |
| Parikh et al., 20207 | 1 | Non-small cell lung cancer | Anterior uveitis | Local corticosteroid | Yes |
| Andrade et al., 20208 | 1 | Non-small cell lung cancer | Retinal vasculitis | Systemic corticosteroid | Yes |
| Vrabic et al., 2021 | 2 | Small cell lung cancer, non-small cell lung cancer | Intermediate uveitis, Posterior uveitis | Systemic corticosteroid | Yes |
Figure 1
Case I. Fundoscopy, at presentation, on one-week and five-week follow-up. Follow-up images show diminishment of vitreous haze and regression of optic disc swelling.
OD(R) = oculus dexter (right); OS(L) = oculus sinister (left)
Figure 2
Case I. Optical coherence tomography (OCT) of optic discs. Optic disc drusen at presentation and on a five-week follow-up. No alteration in optic disc drusen size is visible. Up images show diminishment of vitreous haze and regression of optic disc swelling.
OD(R) = oculus dexter (right); OS(L) = oculus sinister (left)
Figure 3
Case I. Fluorescein angiography at presentation. Early and late frames. Contrast blockage in the upper temporal part of the right optic disc (white arrow), corresponding to a peripapillary haemorrhage. Hypofluorescent dots (black arrow) corresponded to hyperreflective spots on optical coherence tomography (OCT). Fluorescein angiography five weeks on methylprednisolone treatment. Early and late frames. Diminishment of the contrast blockage in the upper temporal part of the right optic disc (white arrow) corresponding to a peripapillary haemorrhage. Hypofluorescent dots (black arrow) are less prominent.
OD(R) = oculus dexter (right); OS(L) = oculus sinister (left)
Figure 4
Case I. Optical coherence tomography (OCT) of optic discs, at presentation, one week on methylprednisolone treatment, five weeks on methylprednisolone treatment. Follow-up shows regression of optic disc swelling.
OD(R) = oculus dexter (right); OS(L) = oculus sinister (left)
Figure 5
Case II. (A) Fundoscopy, prior to non-small cell lung cancer diagnosis in 2013: posterior pole and peripheral retinal changes. (B) Colour fundus photography at presentation in March 2021: multiple flat, grey-white lesions (black arrows) are visible at presentation. (C) Three weeks on methylprednisolone treatment in April 2021: a diminishment of lesions (white arrows) is observed.
OD = oculus dexter; OS(L) = oculus sinister
Figure 6
Case II. (A) Macular optical coherence tomography (OCT) presentation and (B) two weeks on methylprednisolone treatment. Loss of ellipsoid zone and hyperreflective haze in outer plexiform and outer nuclear layers is evident at presentation. Indocyanine angiography at presentation shows hypofluorescent lesions corresponding to ellipsoid zone disruptions (white arrows). Two weeks on methylprednisolone treatment ellipsoid zone appears granular.
OD = oculus dexter; OS(L) = oculus sinister
Figure 7
Case II. Fluorescein angiography at presentation, early and late frames. Note surface capillary net dilatation and late staining of the papilla and hypofluorescent areas on the posterior pole and periphery. Indocyanine angiography at presentation showing hypofluorescent lesions.
OD = oculus dexter; OS(L) = oculus sinister
Table 2
Published cases reporting uveitis and optic disc oedema/papillitis secondary to other immune checkpoint inhibitors
| Author, year | Immune checkpoint inhibitor | Target receptor | Cancer diagnosis | Clinical findings at presentation | Complications | Initial treatment | Discontinuing immune checkpoint inhibitor |
|---|---|---|---|---|---|---|---|
| Hahn et al., 20169 | Ipilimumab | CTLA-4 | Malignant melanoma | AC inflammation, keratic precipitates | Panuveitis, papillitis, intraretinal, subfoveal fluid | Topical prednisolone acetate, brimonidine tartrate timolol maleate, oral prednisolone 20 mg/day | Discontinued |
| Aaberg et al., 201710 | Pembrolizumab | PD-1 | Uveal melanoma | AC inflammation, vitreous cells and haze | Optic disc oedema, posterior uveitis, retinal vasculitis | Intraocular dexamethasone implant | No. |
| Wang et al., 201911 | Nivolumab | PD-1 | Renal carcinoma | AC inflammation, keratoprecipitates, posterior synechiae, vitreous floaters | Panuveitis, papillitis, serous retinal detachment | Intravenous methylprednisolone 500 mg/day, followed by oral prednisolone 30 mg/day tapered over 2 months; recurrence of uveitis managed with periocular methylprednisolone, and intraocular dexamethasone implant | Discontinued, resumed 6 weeks after discontinuation, recurrence of uveitis 2 weeks after resumption |
| Reid et al., 201812 | Pembrolizumab | PD-1 | Malignant melanoma | AC vitreous inflammation, cells, choroidal thickening, posterior synechiae | Panuveitis, optic disc oedema, hypotony | Oral prednisolone 75 mg/day 7 days, tapered over 3 weeks | Discontinued after 12 months commenced on nivolumab therapy |
| Navarro- Perea et al., 201913 | Pembrolizumab | PD-1 | Malignant melanoma | AC inflammation, irido-crystalline synechiae | Optic disc oedema | Topical dexamethasone, cyclopentolate, tropicamide, phenylephrine, oral prednisolone 40 mg/day tapered over 2 months | Discontinued, replaced by vemurafenib and cobimetinib |
| Sun et al., 20205 | Nivolumab | PD-1 | Malignant melanoma | AC inflammation, vitreous cells, and haze | Optic disc oedema, ocular hypertension | Topical prednisolone acetate, oral prednisolone 60 mg/day | n/a |
| Sun 2020et 5 al., | Pembrolizumab | PD-1 | Malignant melanoma | AC inflammation | Hypotony, Papillitis | Topical difluprednate, subtenon triamcinolone acetonide | n/a |
| Sun et al., 20205 | Ipilimumab | PD-1 | Malignant melanoma | AC inflammation, vitreous cells | Macular oedema, Papillitis | Tiamcinolonetransseptal followed by retrobulbar) | n/a |
| Kim et al., 202014 | Pembrolizumab | PD-1 | Renal carcinoma | n/a | Panuveitis, papillitis | Topical steroid, posterior subtenon triamcinolone injection | Discontinued |
| Kim 2020et 14 al., | Pembrolizumab | PD-1 | Uveal melanoma | n/a | Panuveitis, papillitis | Systemic steroid | Discontinued |
| Kim 2020et 14 al. | Pembrolizumab | PD-1 | Lung cancer | n/a | Panuveitis, uveal effusion papillitis, | Systemic steroid | Discontinued |
| Kikuchi et al. 202015 | Nivolumab | PD-1 | Hypopharyngeal cancer | Granulomatous mutton-fat keratic precipitates, AC inflammation, posterior synechiae | Panuveitis, papillitis, serous retinal detachment; Vogt- Koyanagi-Harada disease-like uveitis | Sub-tenon triamcinolone acetonide, followed by methylprednisolone 1000 mg/day 3 days, followed by oral methylprednisolone 50 mg/day tapered by 5 mg every week | Discontinued due to the patient’s deteriorating health |
| Vrabic et al. | durvalumab | PDL-1 | NSCLC | AC inflammation, vitreous cells | Intermediate uveitis, optic dics oedema | Systemic steroid 500 mg/day 3 days, followed by oral methylprednisolone 48 mg/day tapered over 6 weeks | Discontinued |
Figure 8
Case II. Fundus autofluorescence images at presentation show no pathologic changes. Hyperautofluorescent spots are visible three weeks on methylprednisolone treatment.
AF = fundus autofluorescence; OD = oculus dexter; OS(L) = oculus sinister