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Bilateral corneal perforation in Ipilimumab/Nivolumab - associated peripheral ulcerative keratitis
Julia Aschauer1, Ruth Donner1, Jan Lammer1
1Department of Ophthalmology and Optometry, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
Purpose:
To present a case of immune checkpoint inhibitor-induced bilateral peripheral ulcerative keratitis that progressed to corneal perforation requiring keratoplasty in both eyes.
Observations:
We describe the course of a 60-year-old man treated with a combination of Ipilimumab and Nivolumab for metastatic melanoma who presented with foreign body sensation and epiphora in both eyes.Bilateral immune-related peripheral ulcerative keratitis was refractory to topical anti-inflammatory therapy, necessitating repetitive, but unsuccessful cyanoacrylate gluing procedure followed by bilateral lamellar mini-keratoplasty.
Conclusions And Importance:
Combined immune checkpoint inhibition revokes the corneal immune privilege and can lead to auto-immune keratitis with recalcitrant progression to ulceration and perforation.
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