Immune Checkpoint Inhibitor-Induced Ocular Myasthenia Gravis: Case Series and Literature Review

Area of Science:

• Neuro-ophthalmology
• Oncology
• Immunology

Background:

• Immune checkpoint inhibitors (ICIs) enhance anti-cancer immunity but can cause immune-related adverse events.
• ICI-induced myasthenia gravis (ICI-MG) is a known side effect, with limited data on the isolated ocular form (ICI-OMG).

Purpose of the Study:

• To characterize the clinical presentation of patients with ICI-OMG.
• To evaluate treatment responses in ICI-OMG cases.

Main Methods:

• A case series of patients with ICI-OMG from neuro-ophthalmology practices.
• A comprehensive literature review of published ICI-OMG cases.

Main Results:

• Identified 3 new cases and reviewed 12 additional cases of ICI-OMG, predominantly associated with pembrolizumab.
• All patients presented with ptosis; most had diplopia. Antibody tests and sfEMG results were often inconclusive.
• Treatments including corticosteroids and IVIg yielded variable responses.

Conclusions:

• ICI-OMG is a rare condition with diagnostic challenges due to unreliable testing.
• Early recognition is vital; however, patients often experience chronic symptoms with incomplete recovery.
• Further research is needed for improved diagnostic markers and therapeutic strategies.