Clinical features and prognosis of immune checkpoint inhibitor-associated ocular inflammation in Japanese patients: a case series

Purpose To investigate the clinical features of ocular inflammation caused by immune checkpoint inhibitors (ICIs) as immune-related adverse events (irAEs) in Japanese patients. Study design Retrospective observational case series. Methods We reviewed patients with ICI-associated ocular inflammation diagnosed at our institution in 2014–2024. Patient data—background characteristics, primary tumor, causative ICIs, time to onset, laterality, type of inflammation, irAE grade, treatment, visual outcomes, and complications—were analyzed. Stratified analyses were also performed according to the type of ICI. Results The cohort included 7 males and 9 females (mean age, 62.1 ± 14.3 years). The most common primary tumor was malignant melanoma (8 patients). The causative ICIs were pembrolizumab, nivolumab, and nivolumab plus ipilimumab (5, 6, and 5 patients, respectively). The median time of onset was 64 days (12–952) post-administration, with significantly earlier onset in patients receiving nivolumab plus ipilimumab. Ocular inflammation was bilateral in 13 patients. Panuveitis (10 patients) was the most common inflammation type, and 6 patients exhibited Vogt–Koyanagi–Harada (VKH) disease–like uveitis. Grade 3 irAEs were the most frequent (11 patients). ICIs were discontinued in 15 patients and 9 required systemic corticosteroids. At the final follow-up, visual acuity had generally improved; however, 4 patients had a best corrected visual acuity of 20/40 or worse due to complications. Conclusion In Japanese patients reviewed at our institution, ICI-associated ocular inflammation often presented as panuveitis, with VKH disease–like uveitis being relatively common. Visual impairment persisted in one-fourth of the patients, emphasizing the importance of careful management.