Delayed onset of ibrutinib-related posterior uveitis

A 76-year-old male with a nine-year history of ibrutinib treatment for chronic lymphocytic leukemia presented with decreased visual acuity in his left eye. Initial findings revealed cystoid macular edema in the left eye and foveolar ellipsoid zone disruption in the right eye. Fluorescein angiography and indocyanine green angiography demonstrated signs of retinal vasculitis and choroidal hypoperfusion, respectively. Clinical observation and standard anti-inflammatory treatments, including topical corticosteroids, nonsteroidal agents, and subconjunctival triamcinolone, were ineffective. Prompt cessation of the drug led to rapid resolution within 5 days, sustained on follow-up. This report describes a patient who developed posterior uveitis with cystoid macular edema after 108 months of continuous ibrutinib therapy, representing among the longest latencies reported to date. Despite its rarity, ocular inflammation is an increasingly recognized adverse effect of ibrutinib, with bilateral involvement and poor response to conventional therapy being common. Timely cessation of the drug may result in clinical resolution. Regular ophthalmologic screening should be considered in patients undergoing long-term ibrutinib therapy.