Uveal Effusion and Cancer Drugs

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Doctors at the University of Michigan Kellogg Eye Center have reported a se­ries of 3 patients who developed uveal effusion syndrome following treatment with immune checkpoint inhibitors.¹ This new immunotherapy for solid cancers may cause an autoimmune response that adversely affects various organ systems, including the eye.

SIDE EFFECT. Choroidal effusions, observed during the fundus examination.

Ocular toxicity. When the 3 patients at the university-based ocular oncology clinic presented with uveal effusion, “the only recent change in their medi­cal history was the start of the immune checkpoint inhibitor therapy,” said coauthor Hakan Demirci, MD, at the University of Michigan.

The men, ages 52 to 85, all developed uveal effusion 1 to 2 months after initi­ating therapy to treat either melanoma or lung cancer. Prior to presentation, each had received at least 2 infusions of the monoclonal antibodies atezolizumab, nivolumab, or pembrolizumab.

Symptoms and resolution. Anterior chamber inflammation was noted in 2 of the 3 cases, and visual acuity deteri­orated and intraocular pressure spiked in all 3. The syndrome resolved after all immunotherapy was discontinued, without ophthalmic treatment, in 2 of the patients. In the third case, despite ocular issues, the patient continued therapy and died 4 months after initial presentation.

In the clinic. “We can’t advocate stop­ping the medication in these patients,” Dr. Demirci said. “This might not be possible because of the presence of the widespread metastatic disease.” He ad­vised consulting the patient’s oncologist about systemic corticosteroid therapy to treat the eye. If that’s not possible, he recommended observing the patient to see if the uveal effusion worsens and affects vision.

The bottom line. Although the most common ocular complication of immune checkpoint inhibitors is uveitis (seen in about 0.3 to 0.6% of patients), ophthalmologists should be aware of this potential side effect, Dr. Demirci said. “Patients who present with uveal effusion should be questioned regard­ing the use of immune checkpoint inhibitors. Similarly, patients who use immune checkpoint inhibitors and who develop ocular symptoms should be evaluated for uveal effusion.”

—Miriam Karmel

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1 Thomas M et al. JAMA Ophthalmol. 2018;136(5):553-556.

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For more on ocular side effects of immune checkpoint inhibitors, see “Molecularly Targeted Cancer Drugs and Ocular Toxicity” in the October 2017 issue.

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Relevant financial disclosures—Dr. Demirci: None.

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