# Case Report: Serial changes of ocular complications related to immune checkpoint inhibitors pembrolizumab and nivolumab

## TL;DR

A 37-year-old woman with ovarian cancer developed rare eye complications after receiving pembrolizumab and nivolumab, which partially improved with treatment.

## Contribution

This case report highlights rare and persistent ocular side effects of pembrolizumab and nivolumab in a cancer patient.

## Key findings

- The patient experienced bilateral anterior chamber reactions, iris cysts, and macular flecks after pembrolizumab.
- Exudative subretinal fluid recurred after receiving both pembrolizumab and nivolumab, resolving only after stopping immunotherapy.
- Persistent retinal pigment epithelium and ellipsoid-band disruption occurred without vision improvement.

## Abstract

To demonstrate the rare ocular side effects in a patient receiving pembrolizumab and nivolumab for metastatic ovarian cancer.

A 37-year-old woman with recurrent metastatic ovarian cancer presented with blurred vision and photophobia after receiving pembrolizumab. Ocular findings were bilateral anterior chamber reactions, iris cysts, and macular flecks. Optical coherence tomography (OCT) indicated retinal pigment epithelium (RPE) and ellipsoid-band disruption. Her symptoms subsided with topical steroids but fundal appearance persisted despite cessation of immunotherapies. Similar episodes attacked again with multiple exudative subretinal fluid (SRF) developed after she received pembrolizumab and nivolumab. Steroids could cease anterior chamber reactions while SRF only subsided after discontinuation of immunotherapy. Extensive RPE and ellipsoid-band disruption remained without vision improvements.

We report a rare case of uveitis and retinopathy after immunotherapies with sequent pembrolizumab and nivolumab. A serial change of the maculopathy is demonstrated. Possible ocular toxicities during the treatment course should be considered, and the benefits of continuing the immunotherapy must be weighed against the risks.