A 71-year-old man, who was diagnosed with metastatic
lung cancer (
squamous cell carcinoma), presented with blurry vision 2 weeks after the initiation of
pembrolizumab monotherapy. His best-corrected visual acuity (BCVA) was 20/20 OU, and slitlamp examination revealed fine keratic precipitates, anterior chamber cells (1+) and flare (1+) in both eyes. Dilated fundus examination showed no remarkable finding in the right eye and vitreous haze (2+), perivascular exudates, and vessel sheathing in the left eye. Fluorescence angiography demonstrated
dye leakage from the optic disc and both retinal arteries and veins extending from the posterior to the peripheral retina in both eyes. The patient was diagnosed with
panuveitis and
retinal vasculitis as Grade 3 immune-related adverse event (irAE).
Pembrolizumab was discontinued and oral
prednisone 70mg/day was given for 1 week. The dose was reduced to 30mg/day for the next 3 weeks and was then stopped. One month after the treatment, intraocular
inflammation became quiescent. With a good response to the treatment of irAE,
pembrolizumab was restarted. Recurrence of ocular
inflammation occurred over the next 1.5 years, but all of which were successfully treated with sub-Tenon's injection of
triamcinolone acetonide (STTA). The patient maintained BCVA of 30/20 OU at the latest visit.
CONCLUSIONS AND IMPORTANCE: