Ocular inflammatory adverse events of immune checkpoint inhibitors- a multimodal imaging study

Abstract

To describe the spectrum, clinical course, and outcomes of ocular inflammatory adverse events linked to immune checkpoint inhibitors (ICIs) in a Singapore cohort. This retrospective cohort examined six patients who developed ocular symptoms after ICI treatment, including ipilimumab-nivolumab and pembrolizumab. We analyzed clinical features, symptom onset timing, diagnoses, treatments, and outcomes. Six Chinese Singaporean patients (2 men, 4 women; aged 52–72 years) presented with eye redness, pain, and blurred vision 2–14 days after ICI doses. Symptoms arose after the first dose in one patient and after the second to tenth doses in the others. Diagnoses included anterior uveitis ( n  = 3; two granulomatous) and granulomatous panuveitis ( n  = 3), with initial best-corrected visual acuity from 20/25 to 20/100. All received topical and/or systemic corticosteroids without needing to stop ICIs. One patient had anterior uveitis recurrence 3 months later, with both episodes resolving using topical steroids. Two panuveitis cases progressed to sunset-glow fundus; another showed bilateral choroidal granulomas on angiography without visible clinical signs. Final visual acuity ranged from 20/20 to 20/50, with no significant long-term morbidity over 8–72 months of follow-up. Ocular inflammatory adverse events from ICIs in this Singapore cohort showed a predominantly granulomatous spectrum with favorable corticosteroid responses, enabling ICI continuation. Multimodal imaging highlighted choroidal granulomas and sunset-glow fundus evolution. Early recognition and multidisciplinary care preserved vision across diverse Asian patients without oncologic compromise.