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Bilateral Corneal Perforation in a Patient Under Anti-PD1 Therapy
Anaïs Ramaekers1, Sandrine Aspeslagh2, Nele De Brucker3
1Departments of Ophthalmology; and.
Abstract:
Immune checkpoint inhibition has improved the clinical outcomes for numerous patients with cancer. However, the downside is a whole new spectrum of immune-related adverse events. We report a 68-year-old man with a history of nonsmall cell lung cancer presenting with a spontaneous corneal perforation in the right eye after 22 cycles of pembrolizumab. In addition, a chronic central nonhealing epithelial defect developed after performing a penetrating keratoplasty. Treatment with autologous serum drops resulted in complete healing of the corneal ulcer, where other conventional therapies had no effect. One month after reinitiating pembrolizumab therapy, our patient presented again with a corneal perforation in the fellow eye. This case describes relapsing sterile ulcerations associated with pembrolizumab use and presents an unexpected cure.
Insights
Immune checkpoint inhibitor pembrolizumab caused severe eye ulcers in a lung cancer patient. Autologous serum drops unexpectedly healed the ulcers, even after therapy resumed.
Area of Science:
- Ophthalmology
- Oncology
- Immunology
Background:
- Immune checkpoint inhibitors (ICIs) like pembrolizumab offer significant cancer treatment benefits.
- However, ICIs can cause immune-related adverse events (irAEs), affecting various organs.
- Ocular irAEs are less common but can be sight-threatening.
Observation:
- A 68-year-old nonsmall cell lung cancer patient developed corneal perforation after pembrolizumab treatment.
- A persistent epithelial defect occurred post-keratoplasty, unresponsive to standard treatments.
- The patient experienced recurrent corneal perforations in the fellow eye upon pembrolizumab re-challenge.
Findings:
- Autologous serum eye drops led to complete healing of the corneal ulceration.
- This treatment was effective where conventional therapies failed.
- Sterile ulcerations relapsed with continued pembrolizumab, suggesting a direct link.
Implications:
- This case highlights a rare but severe ocular toxicity associated with pembrolizumab.
- Autologous serum drops may represent a novel therapeutic strategy for specific ICI-induced ocular surface disease.
- Further research is needed to understand the mechanisms and management of ICI-related ocular complications.
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