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Arteritic anterior ischemic optic neuropathy secondary to immune checkpoint inhibitors: A case report

Zahin Alam1, Tausif Ahmed Siddiqui2, Mohammed Usman Syed2

  • 1Department of Radiology, Hackensack Meridian School of Medicine, Nutley, NY, USA.

Radiology Case Reports
|July 18, 2025
PubMed

Insights

This case report details a rare instance of arteritic anterior ischemic optic neuropathy (AAION) in a patient undergoing cancer therapy with immune checkpoint inhibitors (ICIs). It highlights the critical need for recognizing ICI-induced ocular complications and improving management strategies.

Area of Science:

  • Ophthalmology
  • Oncology
  • Neurology

Background:

  • Ischemic optic neuropathy (ION) results from reduced optic nerve blood supply, with anterior ischemic optic neuropathy (AION) often linked to giant cell arteritis (GCA).
  • Immune checkpoint inhibitors (ICIs) are used in cancer treatment and can cause neuro-ophthalmic immune-related adverse events (irAEs).

Observation:

  • A 77-year-old male with metastatic renal cell carcinoma on ICI therapy experienced bilateral vision loss.
  • Clinical presentation and MRI findings suggested GCA-associated AAION with orbital impact.

Findings:

  • The patient received corticosteroids, leading to immediate but incomplete visual recovery.
  • A temporal artery biopsy was nonconfirmatory, complicating the diagnosis.

Implications:

  • This case emphasizes the importance of clinical vigilance for ICI-associated ocular complications, particularly the rare AAION.
  • Challenges in diagnosing and managing ICI-induced AAION necessitate further research into effective treatment protocols to prevent permanent vision loss.
Keywords:
Arteritic ischemic optic neuropathyImmune checkpoint inhibitorsImmune-related adverse effectsIschemic optic neuropathyNeuroradiology

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