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Arthi Venkat, Sruthi Arepalli, Sumit Sharma, Naveen Karthik, Careen Lowder, Sunil K Srivastava; Local Therapy for Cancer Immunotherapy-Associated Uveitis. Invest. Ophthalmol. Vis. Sci. 2019;60(9):3532. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Novel cancer immunotherapy upregulates the immune system to inhibit proliferation of malignant cells, but in doing so can lead to immune-related adverse events (irAEs). Uveitis as an irAE can vary in severity and may be potentially blinding. Systemic steroid therapy for bilateral severe immunotherapy-associated uveitis can decrease efficacy of cancer immunotherapy, making local steroid therapy a favorable alternative. This series of patients with immunotherapy-associated uveitis demonstrates efficacy of specific local therapies based on uveitis subtype.
A retrospective chart review was conducted of five patients with cancer immunotherapy-associated uveitis managed with topical steroid eyedrops or intravitreal steroids. Exam data, immunotherapy type and duration, time of uveitis onset, uveitis subtype, ocular imaging findings, local therapy type, dose and duration, and recurrences were recorded.
The average patient age was 56.4 years (median: 54; range: 31 to 75 years). Two patients had anterior uveitis, 2 had panuveitis, and 1 had posterior uveitis. Timing of uveitis onset was 3 to 12 months after the start of immunotherapy. All 5 patients received checkpoint inhibitor therapy; one patient also received targeted therapy. Four of 5 patients were imaged by fluorescein angiography (FA), 3 with peripheral and macular FA leakage. Two of 5 patients had macular edema on OCT. The 2 patients with anterior uveitis were treated with PA1%. One patient with FA leakage without macular edema on OCT was treated with difluprednate drops. The 2 patients with FA leakage and macular edema on OCT were treated with a combination of difluprednate drops and IVTA; these 2 patients had recurrent inflammation that was successfully treated. Patients with posterior and panuveitis were maintained on daily difluprednate topical therapy in one or both eyes; the patients with anterior uveitis did not require maintenance therapy.
We propose a local therapy algorithm for immunotherapy-associated uveitis starting with topical steroids and switching to intravitreal steroids in cases of panuveitis or posterior uveitis. Posterior segment imaging often reveals subclinical inflammation that responds robustly to difluprednate or intravitreal steroid therapy, and patients with posterior segment involvement are more likely than those with isolated anterior chamber inflammation to require aggressive management and long-term maintenance therapy.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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