Bilateral Nongranulomatous Anterior Uveitis with Macular Edema Associated with Ibrutinib Use: A Case Report

To report the case of an adult male patient with chronic lymphocytic leukemia (CLL) under treatment with ibrutinib who developed bilateral anterior uveitis and cystoid macular edema associated with the drug, and to compare this presentation with previously published cases.

A 60-year-old male with a 7-year history of CLL treated with ibrutinib presented to the ophthalmology service with a one-week history of subjective decrease in visual acuity in the right eye, without other associated symptoms. On examination, best corrected visual acuity was 20/60 in the right eye and 20/25-2 in the left eye. Slit-lamp evaluation revealed +0.5 anterior chamber cells in both eyes and a dyscoria in the right eye secondary to posterior synechiae. Fundus examination of the right eye demonstrated elevation of the macula. Optical coherence tomography (OCT) of the macula revealed cystoid macular edema in the right eye, with a central retinal thickness of 528µm. After discussion with the treating oncologist, ibrutinib therapy was continued. The patient was managed with tapering topical corticosteroids, topical nonsteroidal anti-inflammatory drugs (NSAIDs), and mydriatic agents, achieving a favorable clinical response with resolution of the inflammation.

This case underscores the importance of recognizing ocular adverse effects associated with ibrutinib therapy. Increased awareness among clinicians may facilitate early diagnosis and timely intervention, thereby improving the visual prognosis of affected patients. Early ophthalmologic evaluation should be considered in individuals receiving ibrutinib who develop visual symptoms.