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[Corneal melting under PD-1/PD-L1 inhibition].

Leonhard Felix Jacobi1, Sebastian Thaler2, Jan-Philipp Bodenbender2

  • 1Universitätsaugenklinik Tübingen, Elfriede-Aulhorn-Str. 7, 72076, Tübingen, Deutschland. leonhard.jacobi@med.uni-tuebingen.de.

Die Ophthalmologie
|June 10, 2026
PubMed
Summary

Immune checkpoint inhibitors (ICIs) can cause rare but severe ocular side effects. This study highlights two cases of ICI-associated corneal melting, emphasizing the need for early diagnosis and intensive treatment to prevent vision loss.

Keywords:
Corneal perforationCorneal ulcerationImmune checkpoint inhibitorsKeratopathyOcular immune-related adverse events

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Area of Science:

  • Ophthalmology
  • Oncology
  • Immunology

Background:

  • Immune checkpoint inhibitors (ICIs) are widely used in cancer treatment.
  • Ocular immune-mediated adverse events, including corneal complications, are rare but serious side effects of ICIs.

Purpose of the Study:

  • To report two cases of severe corneal disease in patients undergoing ICI therapy.
  • To raise awareness of ICI-associated corneal melting as a differential diagnosis for ocular surface disease in patients on ICIs.

Main Methods:

  • Case report of two male patients with metastatic malignancies treated with ICIs (pembrolizumab and atezolizumab).
  • Detailed description of ocular findings, disease progression, and treatment interventions.
  • Review of clinical presentation and management strategies for ICI-induced ocular toxicity.

Main Results:

  • Patient 1 (metastatic renal cell carcinoma on pembrolizumab) developed conjunctivitis, epithelial defects, and stromal thinning, stabilized with topical N-acetylcysteine and cyclosporine A.
  • Patient 2 (metastatic non-small cell lung cancer on atezolizumab) experienced corneal erosions, ulcerations, perforation, and descemetocele, requiring penetrating keratoplasty and amniotic membrane transplantation.
  • Both patients presented with severe corneal complications under ICI therapy.

Conclusions:

  • ICI-associated corneal melting is a critical diagnosis to consider in patients on ICI therapy presenting with new epithelial defects, ulcerations, or stromal thinning.
  • Early and intensive topical therapy, alongside interdisciplinary management, is crucial for limiting the progression of ICI-induced corneal damage.
  • Prompt recognition and management can help preserve vision in patients experiencing these rare but severe ocular adverse events.