Pathogenic Mechanisms of Immune Checkpoint Inhibitor (ICI)-Associated Retinal and Choroidal Adverse Reactions
Rachana Haliyur1, Susan G Elner1, Therese Sassalos1
1From the Department of Ophthalmology and Visual Sciences, Kellogg Eye Center (R.H., S.G.E., T.S., S.K., M.W.J.), University of Michigan, Ann Arbor, Michigan, USA.
American Journal of Ophthalmology
|January 4, 2025
Summary
Immune checkpoint inhibitor (ICI) therapy can cause vision-threatening retinal inflammation through three main T cell-mediated mechanisms. Early identification and treatment are crucial for favorable visual outcomes in patients receiving ICI treatment.
Area of Science:
- Ophthalmology
- Immunology
- Oncology
Background:
- Immune checkpoint inhibitors (ICIs) are revolutionizing cancer treatment.
- Adverse events, including ocular inflammation, can occur with ICI therapy.
- Understanding these mechanisms is key for patient management.
Purpose of the Study:
- To categorize the mechanisms of ICI-mediated retinal and choroidal inflammation.
- To discuss implications for evaluating and managing these adverse reactions.
- To provide a framework for understanding ICI-related ocular toxicity.
Main Methods:
- Targeted literature review.
- Synthesis and categorization of pathogenic mechanisms.
- Perspective on evaluation and management strategies.
Main Results:
- ICI-induced posterior segment inflammation categorized into 3 mechanisms.
- Type 1: T cell cross-reactivity or expansion causing uveitis-like conditions.
- Type 2: Bystander mechanism leading to retinal vasculitis and occlusions.
- Type 3: Autoantibody-mediated inflammation or paraneoplastic exacerbation.
Conclusions:
- ICI-related posterior segment inflammation can be vision-threatening.
- Mechanisms involve inadvertent T cell-mediated inflammation.
- Prognosis is generally favorable with treatment, but permanent defects can occur.
