Immune checkpoint inhibitor associated ocular hypertension (from presumed trabeculitis)
Purpose: Immune checkpoint inhibitors (ICIs) are associated with a range of immune-related adverse ophthalmic events. To date, there are scant reports of ocular hypertension coupled with ICI-associated uveitis. However, in instances of ocular hypertension in the context of only mild uveitic reaction...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2021-09-01
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| Series: | American Journal of Ophthalmology Case Reports |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2451993621001341 |
| _version_ | 1819066437987205120 |
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| author | Julia Canestraro Anna Do Seth D. Potash Joseph Panarelli Meghan Berkenstock David H. Abramson Jasmine H. Francis |
| author_facet | Julia Canestraro Anna Do Seth D. Potash Joseph Panarelli Meghan Berkenstock David H. Abramson Jasmine H. Francis |
| author_sort | Julia Canestraro |
| collection | DOAJ |
| description | Purpose: Immune checkpoint inhibitors (ICIs) are associated with a range of immune-related adverse ophthalmic events. To date, there are scant reports of ocular hypertension coupled with ICI-associated uveitis. However, in instances of ocular hypertension in the context of only mild uveitic reaction and absence of synechiae, trabeculitis is considered. This series describes our observations of presumed trabeculitis in the setting of ICI therapy and investigates the clinical findings, treatment and outcome of these patients. Observations: Two eyes of 2 patients (both male aged 65 and 43) developed a mild anterior uveitis and elevated intraocular pressure (IOP) with open angles and no evidence of peripheral anterior synechiae in association with ICI treatment for their malignancy; and were considered to have presumed unilateral trabeculitis. The patients underwent 10 cycles (6.53 months) and 2 cycles (3.33 months) respectively of ICI therapy before developing ophthalmic symptoms. Neither patient was on systemic or topical steroid treatment at time of diagnosis and there was no suspicion of a viral etiology for the inflammation. Following management, the anterior uveitis resolved and IOP rapidly returned to normal in both eyes: ICI therapy was discontinued in both patients (and uneventfully re-challenged at a lower dose in one patient) and both eyes were treated with a combination of topical and/or oral glaucoma medications and topical steroids. Conclusions and Importance: Uveitic ocular hypertension has been described with ICI. However, another immune-related mechanism for ocular hypertension with unique clinical characteristics, includes trabeculitis. We describe two cases of trabeculitis in the setting of ICI-therapy. The intraocular inflammation and elevated intraocular pressure which characterizes trabeculitis often responds rapidly to conservative treatment. In both patients checkpoint inhibitor therapy was discontinued and, in one patient, was re-challenged at a lower dose without recurrence. Immunotherapy is now more widely used for cancer treatment and its potential ocular manifestations should be shared with the ophthalmic community. |
| first_indexed | 2024-12-21T16:02:21Z |
| format | Article |
| id | doaj.art-6acd8c84314745e6bbc43ecf58877ef7 |
| institution | Directory Open Access Journal |
| issn | 2451-9936 |
| language | English |
| last_indexed | 2024-12-21T16:02:21Z |
| publishDate | 2021-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | American Journal of Ophthalmology Case Reports |
| spelling | doaj.art-6acd8c84314745e6bbc43ecf58877ef72022-12-21T18:57:58ZengElsevierAmerican Journal of Ophthalmology Case Reports2451-99362021-09-0123101125Immune checkpoint inhibitor associated ocular hypertension (from presumed trabeculitis)Julia Canestraro0Anna Do1Seth D. Potash2Joseph Panarelli3Meghan Berkenstock4David H. Abramson5Jasmine H. Francis6Ophthalmic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Corresponding author. Ophthalmic Oncology Department, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA.New York University, Langone Health, New York, NY, USANew York Medical College, Valhalla, NY, USANew York University, Langone Health, New York, NY, USAWilmer Eye Institute at Johns Hopkins University, Baltimore, MD, USAOphthalmic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Cornell Medical Center, New York, NY, USAOphthalmic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Cornell Medical Center, New York, NY, USAPurpose: Immune checkpoint inhibitors (ICIs) are associated with a range of immune-related adverse ophthalmic events. To date, there are scant reports of ocular hypertension coupled with ICI-associated uveitis. However, in instances of ocular hypertension in the context of only mild uveitic reaction and absence of synechiae, trabeculitis is considered. This series describes our observations of presumed trabeculitis in the setting of ICI therapy and investigates the clinical findings, treatment and outcome of these patients. Observations: Two eyes of 2 patients (both male aged 65 and 43) developed a mild anterior uveitis and elevated intraocular pressure (IOP) with open angles and no evidence of peripheral anterior synechiae in association with ICI treatment for their malignancy; and were considered to have presumed unilateral trabeculitis. The patients underwent 10 cycles (6.53 months) and 2 cycles (3.33 months) respectively of ICI therapy before developing ophthalmic symptoms. Neither patient was on systemic or topical steroid treatment at time of diagnosis and there was no suspicion of a viral etiology for the inflammation. Following management, the anterior uveitis resolved and IOP rapidly returned to normal in both eyes: ICI therapy was discontinued in both patients (and uneventfully re-challenged at a lower dose in one patient) and both eyes were treated with a combination of topical and/or oral glaucoma medications and topical steroids. Conclusions and Importance: Uveitic ocular hypertension has been described with ICI. However, another immune-related mechanism for ocular hypertension with unique clinical characteristics, includes trabeculitis. We describe two cases of trabeculitis in the setting of ICI-therapy. The intraocular inflammation and elevated intraocular pressure which characterizes trabeculitis often responds rapidly to conservative treatment. In both patients checkpoint inhibitor therapy was discontinued and, in one patient, was re-challenged at a lower dose without recurrence. Immunotherapy is now more widely used for cancer treatment and its potential ocular manifestations should be shared with the ophthalmic community.http://www.sciencedirect.com/science/article/pii/S2451993621001341TrabeculitisImmunotherapyCheckpoint inhibitorOcular hypertension |
| spellingShingle | Julia Canestraro Anna Do Seth D. Potash Joseph Panarelli Meghan Berkenstock David H. Abramson Jasmine H. Francis Immune checkpoint inhibitor associated ocular hypertension (from presumed trabeculitis) American Journal of Ophthalmology Case Reports Trabeculitis Immunotherapy Checkpoint inhibitor Ocular hypertension |
| title | Immune checkpoint inhibitor associated ocular hypertension (from presumed trabeculitis) |
| title_full | Immune checkpoint inhibitor associated ocular hypertension (from presumed trabeculitis) |
| title_fullStr | Immune checkpoint inhibitor associated ocular hypertension (from presumed trabeculitis) |
| title_full_unstemmed | Immune checkpoint inhibitor associated ocular hypertension (from presumed trabeculitis) |
| title_short | Immune checkpoint inhibitor associated ocular hypertension (from presumed trabeculitis) |
| title_sort | immune checkpoint inhibitor associated ocular hypertension from presumed trabeculitis |
| topic | Trabeculitis Immunotherapy Checkpoint inhibitor Ocular hypertension |
| url | http://www.sciencedirect.com/science/article/pii/S2451993621001341 |
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