Table 1:
Clinical characteristics of patients, their systemic disease, presenting symptoms, their eyes, their ophthalmic findings and their outcome
| Patient | Age (yrs) | Gender | Drug at time of dx | No. of ICI cycles prior to ophthalmic dx | Time to follow up (mos) | Alive(Y/N) | Primary Cancer Dx | Ocular symptoms | Pain (Y/N) | Other intraocular inflammation |
|---|---|---|---|---|---|---|---|---|---|---|
|
| ||||||||||
| 1 (MSK) | 61 | F | Ipilimumab 3mg/Kg + Nivolumbab 1mg/kg q 3weeks | 3 | 32.53 | Y | Cutaneous melanoma | Decreased vision, floaters, “smudge” | N | Anterior uveitis OU |
| 2 (MSK) | 58 | F | Ipilimumab 3mg/Kg + Nivolumab 1mg/kg q 3weeks, followed by Nivolimab | 52 | 12.10 | Y | Cutaneous melanoma | Decreased vision, Floaters, halos | N | None |
| 3 (MSK) | 59 | F | Nivolumab 240mg q3wks | 2 | 7.03 | N | SCLC | Decreased vision, “large” floater | N | None |
| 4 (MSK) | 71 | M | Pembrolizumab 200mg monthly, pemetrexed 200mg | 3 | 6.47 | N | NSCLC | Decreased vision | N | None |
| 5 (MSK) | 54 | F | Ipilimumab 1mg/Kg q6wks + Nivolumab 240mg q3wks | 4 | 2.53 | Y | NSCLC | Decreased vision | N | Choroiditis, intraretinal edema OU |
| 6 (MSK) | 68 | M | Ipilimumab 3mg/Kg + Nivolumbab 1mg/kg q 3weeks | 4 | 2.43 | Y | Cutaneous melanoma | Peripheral vision loss | N | None |
| 7 (MSK) | 73 | F | Atezolizumab 1200mg q3weeks | 95 | 1.60 | Y | Renal Cell Carcinoma | “Big” Floaters | N | Anterior uveitis, rare vitreous cells |
| 8 (MEE) | 69 | F | Pembrolizumab 2 mg/kg q3 weeks | 7 | 4.47 | N | NSCLC | Decreased vision | N | None |
| 9 (MEE) | 65 | M | Ipilimumab 3 mg/kg + Nivolumab 1 mg/kg q3 weeks | 4 | 1.17 | Y | Cutaneous melanoma | Decreased vision | N | None |
| 10 (MEE) | 63 | M | Nivolumab 2 mg/kg q2 weeks | 10 | 3.37 | Y | Cutaneous melanoma | Decreased vision, redness | Y | Anterior uveitis OU |
| 11 (WEI) | 58 | M | Ipilimumab 3mg/kg + Nivolumab 1mg/kg q3 weeks; Nivolumab 1mg/kg rechallenge once | 4 | 6.00 | Y | SCLC | Decreased vision | N | None |
| Patient | Laterality of Optic Neuritis | APD involved eye? (Y/N) | Optic nerve exam at dx | MRI type (sequences): findings | Initial visual field pattern (mean deviation dB) | Ophthalmic Treatment | Optic nerve exam at after treatment | Posttx visual field pattern (mean deviation dB) |
|---|---|---|---|---|---|---|---|---|
|
| ||||||||
| 1 (MSK) | Bilateral | N | Trace nasal edema OU | MRI orbits (T1, T2, fatsat): central T2 hyperintense changes of bilateral intraorbital optic nerves continuous to prechiasm, enhancement of sheath complexes | Cecocentral detect OD (NR) | PO Pred 80mg w/ taper over 1 mos, topical prednisolone, timolol/dorzolamide | Trace nasal pallor | Cecocentral detect OD (NR) |
| 2 (MSK) | Bilateral | N | Trace diffuse edema OU | MRI brain and orbits (T1, T2, fatsat, DWI): no abnormality | Cecocentral defect OU (−6.82 OD, −6.73 OS) | IV DXM 3g, IVIg x 1, ritux x 3, PLEX x 5, PO pred 80mg taper over 2 mos | Trace diffuse pallor OU | Cecocentral defect OU (−5.64 OD, −6.44 OS) |
| 3 (MSK) | Unilateral (left) | Y | Full disc OS, with hemorrhage, progressed to 2+ disc edema | MRI orbits at time of 20/30 vision (T1, T2, fatsat, DWI, FLAIR): no abnormality | Diffuse OS (−24.81 OS) | PO pred 60mg | Pallor of superior left disc | NA |
| 4 (MSK) | Bilateral | Y | Diffuse disc pallor and edema | MRI orbits (T1, T2, fatsat, DWI): Papilledema, bilateral enhancement intraorbital optic nerve sheaths | Diffuse OU (−30.4 OD, −24.86 OS) | IV methylpred 1g x 5 days, PO pred 80mg w/ taper over 2 mos | Disc pallor with resolved edema, thinning OU | Diffuse OU (−29.25 OD, − 24.75 OS) |
| 5 (MSK) | Bilateral | Y | Disc edema OU | MRI brain and orbits (T1, T2, fatsat, DWI): mild enlargement of left greater than right distal intraorbital optic nerve, no enhancement | Inf arcuate OU (−4.2 OD, −9.48 OS) | PO pred 80mg w/ taper over 2 mos | Normal | No defect (0.95 OD, − 0.35 OS) |
| 6 (MSK) | Unilateral (right) | Y | Disc sectoral edema OD (SN) | MRI brain (T1, T2, fatsat DWI, FLAIR): no abnormality | Inf altitudinal OD, Inf arcuate OS (−15.8 OD, −5.85 OS) | IV methylpred x 3days, PO pred 1 mg/kg/day w/ taper over 2 mos | SN disc pallor, corresponding NFL OCT thinning | Inf arcuate OD, Inf arcuate OS (−6.83 OD, 0.03 OS) |
| 7 (MSK) | Bilateral | N | 2+ optic nerve edema OU | None | No defect OU (0.23 OD, 0.44 OS) | PO pred 80mg w/ taper over 2 mos | Normal | No defect OU (0.69 OD, 0.463 OS) |
| 8 (MEE) | Unilateral (right) | Y | Optic nerve edema OD | MRI orbits (T1, T2, fatsat, DWI, FLAIR): no abnormality | Inf arcuate defect OD (−12.37) | IV methylpred x 48 hrs, PO DXM 4 mg | Optic nerve pallor OD | NA |
| 9 (MEE) | Unilateral (left) | Y | Optic nerve edema OS superior>inferior, flame hemorrhages | MRI orbits (T1, T2, fatsat, DWI, FLAIR): no abnormality | Cecocentral OS (−2.84) | None | Slightly less edema, resolved flame hemorrhages | NA |
| 10 (MEE) | Bilateral | N | Optic nerve edema OD, and then edema 2 weeks later OS | MRI orbits (T1, T2, fatsat, DWI, FLAIR): no abnormality | Inferior arcuate OD, superior altitudinal OS (NA) | IV methylpred, PO pred 60 mg w/ taper. topical difluprednate, timolol/ dorzolamide, brimonidine | Optic nerve pallor OU | Inferior arcuate OD, superior altitudinal OS (6.09 OD, −9.52 OS) |
| 11 (WEI) | Bilateral | Y | Pink, C/D asymmetry OU (0.5 OD; 0.7 OS) | MRI orbits (T1, T2, fatsat, DWI, FLAIR): Left greater than right optic nerve enhancement: Prechiasmal OU, canalicular OS | Diffuse OU (−22.71 OU) | IV methylpred 1g x 5 days and 5 PLEX, PO pred 50mg w/ taper over 6 mo | Pink OD, 4+ pallor OS | NA |
dx = diagnosis, ICI = immune checkpoint inhibitor, SCLC = small cell lung cancer, NSCLC = nonsmall cell lung cancer, MSK = Memorial Sloan Kettering, MEE = Mass Eye & Ear, WEI = Wilmer Eye Institute, APD = afferent pupillary defect, dx = diagnosis, MRI = magnetic resonance imaging, HVF = Hymphrey visual field, OU = oculus uterque, OD = oculus dextrus, OS = oculus sinister, Inf = inferior, sup = superior, SN = superonasal, MSK = Memorial Sloan Kettering, MEE = Mass Eye & Ear, WEI = Wilmer Eye Institute, pred = prednisone, DXM = dexamethasone, ritux = rituximab, PLEX = plasmaexchange, Posttx = post-traetment, mos = months, NR = not recorded, T1 = T1-weighted, T2 = T2-weighted, fatsat = fat-saturation, DWI = diffusion-weighted imaging, FLAIR = fluid-attenuated inversion recovery, NA = not available