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.

Keywords: Cataracts; Hypotony; Ipilimumab; Nivolumab; Optical coherence tomography angiography; Uveitis.

Fig. 1

Slit lamp, fundus, and OCT horizontal B-scan images (right eye). a, b Slit lamp photographs showing posterior synechiae and nuclear cataract (a) and keratic precipitates (b) (white triangle). c Fundus photograph showing cup-to-disk ratio of 0.1, small diameter (1.56 mm), peripapillary atrophy, narrow arterioles, cotton wool spots (black arrow), and hard exudates (white arrow). d, e OCT horizontal B-scan imaging with normal retina and choroid and no evidence of retinal edema (d) and optic nerve head crowding (e).

Fig. 2

OCTA scans showing normal nerve fiber layer thickness (a), macula with reduced vessel density, average density 38.5% (normal ≥50%) (b), and optic nerve with mildly reduced vessel density, average density 47.5% (normal ≥50%) (c).