# Case Report: Laser speckle flowgraphy in a patient with uveitis due to immune-related adverse events by immune checkpoint inhibitors

## TL;DR

This case report shows how laser speckle flowgraphy can detect changes in choroidal blood flow in a patient with uveitis caused by immune checkpoint inhibitors.

## Contribution

The study presents a novel application of laser speckle flowgraphy to assess choroidal circulation in immune-related uveitis.

## Key findings

- Choroidal blood velocity decreased at the onset of ICI uveitis compared to baseline.
- Corticosteroid treatment led to resolution of uveitis and improvement in choroidal circulation.
- Combining MBR and CCT measurements may help monitor and manage ICI-induced uveitis.

## Abstract

It remains unknown whether choroidal circulation could be altered at the onset of immune checkpoint inhibitor (ICI) uveitis compared with that before ICI treatment. Herein we report a patient with Vogt-Koyanagi-Harada (VKH) disease-like uveitis in the unaffected eye as an immune-related adverse effect (irAE) due to ICIs for metastatic choroidal melanoma who had received enucleation. Moreover, choroidal circulation and choroidal thickness were measured before and after treatment.

A 58-year-old man had a medical history of enucleation in his left eye due to choroidal melanoma 6 years ago. Metastatic lesions in the gastrointestinal tracts and lung were found, and then he received ICIs three times. About 1 month later, he suffered from blurred vision and metamorphopsia in his right eye. Choroidal circulation was evaluated by mean blur rate (MBR), a relative value showing choroidal blood velocity on laser speckle flowgraphy. Central choroidal thickness (CCT) was measured on optical coherence tomography.

Since ophthalmic findings revealed VKH-like uveitis, oral prednisolone of 30 mg was given for 2 weeks, which were then tapered. MBR was reduced and CCT increased at the onset of ICI uveitis compared with its baseline and resolution after corticosteroid treatment.

Choroidal circulation was disrupted, possibly due to ICI-induced autoinflammatory reaction to the choroid, which was managed by corticosteroid treatment. The combination of MBR and CCT could be a useful biomarker for managing the patients with VKH-like uveitis by ICIs.