Ocular Microbiology and Immunology Group
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2016 OMIG Abstract 17

Bilateral Anterior Uveitis as Complication of Programmed Death-Ligand Inhibitor Chemotherapeutic Agents
Shruti Aggarwal MBBS¹, Justin N Karlin MD¹, Ryan Gentzler MD², Jeffery Golen¹ MD
¹Dept of Ophthalmology, University of Virginia, Charlottesville, VA
²Division of Hematology/Oncology, Dept of Internal Medicine, University of Virginia, Charlottesville, VA

Background: Medication-induced uveitis, although rare, is a well-documented phenomenon. Programmed death-ligand (PD-L) 1 or 2 inhibitors including nivolumab and pembrolizumab are relatively new chemotherapeutic agents that are being used for treatment of solid tumors including non-small cell lung carcinoma, melanoma and renal carcinoma. These agents enhance immune destruction of tumor cells. However, such stimulation of the immune response may cause collateral autoimmune activation and can result in drug-induced uveitis.

Purpose: We report a series of 3 patients who developed chronic bilateral anterior uveitis after starting PD-L1 or PD-L2 chemotherapy.

Methods: Retrospective case series of 3 patients who developed chronic bilateral anterior uveitis after starting treatment with nivolumab (n=2) and pembrolizumab (n=1), seen at the Department of Ophthalmology, UVA from November 2015 to June 2016. Charts were reviewed and parameters recorded were past medical history, current systemic therapy, ocular signs and symptoms and treatment. Main outcome measures included BCVA, intraocular pressure and grade of anterior chamber inflammation (recorded from 0-4).

Results: Two patients (67 y/o F and 75 y/o M) were undergoing treatment with nivolumab for lung adenocarcinoma and malignant melanoma respectively, who developed bilateral anterior uveitis, 3 months and 5 months after starting chemotherapy. The third patient (52 y/o F) started pembrolizumab therapy for malignant melanoma and developed bilateral anterior uveitis 1 week after. All patients were treated with topical and oral steroids and improved by at least one line in BCVA after therapy. The chemotherapy was continued in all patients.

Conclusion: Immune modulation by newer cancer therapies increase patient survival, but have potential to induce uveitis. Timely identification of the offending agent limits visual morbidity and helps guide treatment. Close collaboration between the ophthalmologist and the oncologist may help determine the risks and benefits of continuing the treatment.

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