Drugs, Inflammation, and the Eye

Purpose: To examine the nature and frequency of ocular side effects due to systemic target therapy with BRAF and MEK inhibitors as well as immunotherapy with cytotoxic T-lymphocyte antigen 4 (CTLA-4) and programmed cell death 1 (PD-1) monoclonal antibodies used in the treatment of cutaneous malignant melanoma (CMM). Design: While proven effective in cancer treatment, target therapy and immunotherapy have been associated with ocular side effects likely due to their ability to alter the immune privilege of the eye. We conducted a retrospective chart review of patients undergoing target and immunotherapy for CMM and documented all associated eye findings. Methods: We reviewed the records of 34 patients receiving target and immunotherapy for CMM who were examined in the academic ophthalmology clinic between 2012 and 2017. Results: Ocular side effects were present in 41.1% of patients in this study with 14.7% presenting with uveitis. Patients undergoing therapy with either vemurafenib only or dabrafenib/trametinib combination therapies comprised 70.5% of the study cohort. Ocular side effects occurred in 45.5% and 46.1% of patients on vemurafenib and dabrafenib/trametinib combination therapy, respectively. About 47.5% of males presented with ocular side effects compared to 30.5% of females. Notably, 13/14 patients with ocular symptoms recovered. Conclusion: This study highlights the frequency of ocular side effects in patients treated with target therapy and immunotherapy for CMM and shows that symptom resolution can be effectively achieved with proper ophthalmic care. Further research is required to answer whether cessation of these therapies is mandatory during ophthalmic treatment.

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“…Additionally, our results match current data that indicate a slight predominance of bilateral versus unilateral uveitis. 36,37…”

Section: Discussionmentioning

confidence: 99%

Ocular side effects of target therapy and immunotherapy in patients with cutaneous malignant melanoma

Eikenberry

Harris

Torabi

et al. 2020

European Journal of Ophthalmology

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“…[20][21][22] Topical prostaglandin analogues may cause an acute non-granulomatous or chronic granulomatous AU. Topical brimonidine has been associated with a chronic AU, characterized by diffusely distributed stellate or micro-granulomatous KPs and a mild anterior chamber reaction, with or without concurrent conjunctivitis.…”

Section: Toxic Uveitismentioning

confidence: 99%

“…20,21 Biphosphonates that are used for the treatment of osteoporosis may cause an acute bilateral nongranulomatous AU with or without scleritis. [20][21][22] Intravenous or intravitreal administration of cidofovir, an antiviral agent used for the treatment of CMV retinitis, may cause non-granulomatous AU typically associated with ocular hypotony. 20,21 Bacillus Calmette-Guérin (BCG) vaccination or intravesical BCG for the treatment of bladder cancer may rarely cause an acute bilateral non-granulomatous or granulomatous AU.…”

Section: Toxic Uveitismentioning

confidence: 99%

“…20 Melanoma or metastatic cancer patients receiving immune checkpoint inhibitors, such as ipilimumab, pembrolizumab, or nivolumab, may present with red eyes and mild or severe AU with posterior synechiae which may also be associated with keratitis. 22 Antitumor necrosis factor (TNF) agents, particularly etanercept, may cause a paradoxical intraocular inflammation, which may sometimes present as a sarcoid-like granulomatous anterior uveitis. 20,21 Bilateral acute iris transillumination (BAIT) syndrome, which can mimic acute iridocyclitis, has been linked to oral fluoroquinolones, especially moxifloxacin Figure 3.…”

Section: Toxic Uveitismentioning

confidence: 99%

See 1 more Smart Citation

Challenges of Diagnosing Viral Anterior Uveitis

Groen-Hakan

Babu²,

Tuğal-Tutkun

et al. 2017

Ocular Immunology and Inflammation

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The viral causes of anterior uveitis (AU) emerged with the use of novel molecular diagnostic tests and serologic tests adapted for small volumes (Goldmann-Witmer Coefficient). The viral causes of AU may be underestimated, and some of the presumed idiopathic AU cases will probably be proven to be of viral origin in the coming years. So far, a viral origin of AU was suspected in patients who presented with unilateral hypertensive AU. It is not clear which clinical presentations should raise a suspicion of viral etiology. There is an overlap in the clinical manifestations of AU caused by viruses and other non-viral forms of AU. A viral cause of AU should be suspected in patients with unilateral AU, exhibiting small or medium sized KPs, some form of iris atrophy, high IOP and early development of a cataract and the definitive diagnosis can be proven by aqueous humor analysis.

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“…6,7 Several summaries of vaccine-associated uveitis have appeared over the past decade. [8][9][10][11][12][13][14][15] In the most comprehensive review from 2016, 10 Benage and Fraunfelder identified 289 cases using Medline literature searches and a systematic review of three surveillance systems: the National registry of Drug-Induced Ocular Side Effects (www.eyedrugregistry.com), the UMC, and the VAERS. Vaccination for hepatitis B virus (HBV), 15 either alone or in combination, was reported most frequently (40.5%), followed by immunization for human papillomavirus (HPV; 15.6%), 12 influenza virus (9.7%), Bacille Calmette-Guerin (BCG; 7.3%), measles-mumps-rubella (MMR) alone or in combination (4.8%), varicella virus alone or in combination (4.8%), and hepatitis A virus (HAV) alone or in combination (2.4%).…”

mentioning

confidence: 99%