Table 1.
Characteristics, Findings, and Outcome of Patients Who Developed Ocular Immune-Related Adverse Event after Nivolumab with or without Ipilimumab
| Case | M/ F |
Primary Cancer |
Age at Ocular Symptom, yrs |
Immunotherapy | No. of Immunotherapy Cycles at the Onset of Ocular Symptoms |
VA at Presentation |
Ocular Finding | Treatment | Concurrent Systemic irAE |
Cessation Immunotherapy |
Systemic Outcome |
Ocular Outcome |
Duration of Follow- up Since Ocular Event (mos) |
|
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| OD | OS | |||||||||||||
| 1 | F | Uveal melanoma | 62 | Nivolumab 1 mg/kg plus ipilimumab 3 mg/kg | 1 | 20/20 | 20/400 | Myasthenia gravis - blepharoptosis and diplopia | Systemic corticosteroids,IVIG | Lipase elevation Transaminitis | Yes | POD | 20/20, 20/400 Improving diplopia and ptosis | 7 |
| 2 | M | Non—small cell lung carcinoma | 51 | Nivolumab 240 mg + ipilimumab 102 mg | 1 | 20/20 | 20/20 | Conjunctival papillary reaction andSCH OU | Neomycin/ polymyxin B/ dexamethasone eye drops | Lipase elevation Transaminitis | Yes | PR | 20/20, 20/20 Complete resolution | 3 |
| 33 | F | Cutaneousmelanoma | 45 | Nivolumab 3 mg/kg | 2 | 20/25 | 20/20 | Severe dry eyes OU | Topical cyclosporine | New joint pain in hands, elbows, knees, feet | No | CR | 20/20 OU Complete resolution | 27 |
| 43 | M | Cutaneousmelanoma | 58 | Nivolumab 1 mg/kg plus ipilimumab 3 mg/kg x 2 then nivolumab monotherapy x 6 | 8 | 20/400 | 20/50 | AtraumaticcornealperforationOD | Corneal glue, bandage contact lens, artificial tears, topical cyclosporine 0.05% eye drops | Colitis, lipase elevation | Yes | POD | 20/25 OU Complete resolution with residual corneal scarring | 54 |
| 5 | F | Uvealmelanoma | 71 | Nivolumab 1 mg/kg plus ipilimumab 3 mg/kg x 2 | 2 | 20/40 | 20/400 | Keratic precipitates and anterior uveitis OU | Topical prednisolone acetate 1% then topical difluprednate 0.05%,systemic corticosteroid | Rash, colitis,panhypopituitarism | No | POD | 20/60, 20/400 Complete resolution of anterior chamber cells | 25 |
| 6 | M | Cutaneousmelanoma | 74 | Nivolumab 1 mg/kg plus ipilimumab 3 mg/kg x 2 | 2 | 20/25 | 20/30 | Keratic precipitates, peripheral anterior synechiae, and anterior uveitis OU | Topical prednisolone acetate 1%, topical atropine, systemic corticosteroid | Diarrhea | No | PR | 20/25, 20/30 Resolution of cells | 1 |
| 7 | F | Cutaneousmelanoma | 53 | Nivolumabmonotherapy x 9 then nivolumab 1 mg/kg plus ipilimumab 3 mg/kg x 1 | 10 | 20/25 | 20/20 | Anterior uveitis and vitritisOU | Systemic and topical corticosteroid | Lipase elevation, hypo-pituitarism | Yes | POD | 20/20, 20/20 Chronic uveitis requiring topical therapy | 26 |
| 8 | M | Cutaneous melanoma | 67 | Nivolumab 1 mg/kg plus ipilimumab 3mg/kg x 3 | 3 | 20/40 | 20/40 | Anterior uveitis, 360° posterior synechiae OU | Topical prednisolone acetate 1%,sub-tenon corticosteroid,systemic corticosteroid | Nephritis | Yes | POD | 20/150, 20/40 Choroidal effusion and hypotony maculopathy | 2 |
| 9 | M | Cutaneousmelanoma | 69 | Nivolumab 1 mg/kg plus ipilimumab 3mg/kg x 4 | 4 | 20/40 | 20/150 | Anterior uveitis and choroidal effusion OU | Systemic and topical corticosteroid | Rash, myalgia, fatigue | Yes | PR | 20/50, 20/150 Persistent choroidal effusion | 1 |
| 10 | F | Cutaneousmelanoma | 68 | Nivolumab 1 mg/kg monotherapy x 2 then nivolumab 3 mg/kgmonotherapy x 5 | 7 | 20/30 | 20/40 | CME OU | Systemic corticosteroid for pneumonitis (not for ocular event) | Pneumonitis | Yes for pneumonitis | S | Unknown | 12 |
| 11 | F | Cutaneous melanoma | 54 | Nivolumab 1 mg/kg plus ipilimumab 3 mg/kg | 1 | 20/70 | 20/70 | Subfoveal fluid OU | Systemic corticosteroid | Colitis, pneumonitis, transaminitis | Yes | POD, deceased | 20/25 OU Complete resolution | 29 |
| 12 | M | Cutaneous melanoma | 52 | Nivolumab 1 mg/kg plus ipilimumab 3 mg/kg | 6 | 20/25 | 20/40 | Serous RD OU | Systemic and sub-tenon corticosteroid | Transaminitis | Yes | CR | CF, 20/400 Chronic serous RD OU | 79 |
| 134 | F | Cutaneous melanoma | 43 | Nivolumab 1 mg/kg plus ipilimumab 3 mg/kg | 1 | 20/30 | 20/100 | VKH-like syndrome OU | Systemic corticosteroid | Diffuse vitiligo | Yes | POD | 20/20 OU Complete resolution ofVKH | 85 |
| 14 | F | Cutaneous melanoma | 79 | Nivolumab 1 mg/kg plus ipilimumab 3 mg/kg | 1 | 20/20 | 20/25 | MAR OU | Systemic corticosteroid,IVIG | Transaminitis, rash, hypophysitis | Yes | CR | 20/20 OU Ongoing MAR on IVIG | 10 |
| 15 | F | Cutaneous melanoma | 61 | Nivolumab 1 mg/kg plus ipilimumab 3 mg/kg x 4 thennivolumab monotherapy x 1 | 5 | 20/20 | 20/100 | Optic discswelling OU | Systemiccorticosteroid,infliximab | Colitis, pleural effusion | Yes | POD, deceased | 20/70, CF Bilateral optic neuropathy with pallor | 15 |
CF = counting fingers; CME = cystoid macular edema; CR = complete response; irAEs = immune-related adverse events; IVIG = intravenous immunoglobulin; MAR = melanoma-associated retinopathy; OD = left eye; OS = left eye; OU = both eyes; POD = progression of disease; PR = partial response; RD = retinal detachment; S = stable; SCH = subconjunctival hemorrhage; VA = visual acuity; VKH = Vogt-Koyanagi-Harada.