Pembrolizumab and Nivolumab-induced ocular complications: a case report with literature review
Purpose
to demonstrates the ocular side effects in a patient receiving Pembrolizumab and Nivolumab for metastatic ovarian cancer
Methods
a case report with brief literature review
Results
A 37-year-old female with recurrent metastatic ovarian cancer presented with blurred vision (OU) 1 month after receiving Pembrolizumab. Ocular examinations revealed a best-corrected visual acuity (BCVA) of 0.4/0.2 using Landolt C chart, bilateral fine keratic precipitates, cells in the anterior chamber, iris cysts, and macular mottling. Optical coherence tomography indicated outer retinal destruction and visual field reported peripheral defects and an enlarged blind spot. Her BCVA recovered to 0.9/0.7 and the anterior chamber cells and iris cysts subsided with topical prednisolone and cycloplegics for 2 weeks. However, the fundus appearance persisted despite ceasing the immunotherapy. She suffered from similar episodes after receiving Pembrolizumab and Nivolumab one year later, and even developed multiple subretinal fluid (SRF) demonstrating strong staining with mild leakage over the lesions on fluorescein angiography. Oral and topical steroids could cease anterior chamber reactions while SRF only subsided after discontinuation of Pembrolizumab and Nivolumab. Extensive outer retina destruction remained the same without obvious vision improvements.
Conclusion
This case report demonstrates that Pembrolizumab and Nivolumab-related ocular side effects can include bilateral anterior uveitis, iris cysts, and outer retinal destruction. This is also the first case report revealing nearly symmetric retinopathy after the immunotherapy.
Conflict of interest
No
Author 1
Last name
CHO
Initials of first name(s)
WH
Department
Ophthalmology
City
Kaohsiung
Country
Taiwan
Author 2
Last name
Kuo
Initials of first name(s)
HK
Department
Ophthalmology
City
Kaohsiung
Country
Taiwan
Author 3
Last name
Chiang
Initials of first name(s)
WY
Department
Ophthalmology
City
Kaohsiung
Country
Taiwan
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