Ophthalmic Immune-Related Adverse Events in Cancer Immunotherapy: Tissue-Specific Mechanisms, Clinical Phenotypes,...

Area of Science:

• Ophthalmology
• Immunology
• Oncology

Background:

• Immune checkpoint inhibitors (ICIs) enhance anti-tumor immunity but can disrupt ocular immune homeostasis.
• Ophthalmic immune-related adverse events (OirAEs) are uncommon but can lead to severe visual impairment.
• Standardized classification of OirAEs is evolving with new international consensus criteria.

Purpose of the Study:

• To review ICI-associated ocular toxicity, focusing on immune mechanisms and clinical impact.
• To integrate current evidence on the pathogenesis of OirAEs.
• To propose a mechanism-informed management strategy for OirAEs.

Main Methods:

• Literature review of ICI-associated ocular toxicity.
• Analysis of immune mechanisms underlying OirAEs.
• Integration of clinical manifestations and management strategies.

Main Results:

• ICI blockade (PD-1/PD-L1, CTLA-4) can impair ocular immune privilege and promote autoimmunity.
• Mechanisms include T-cell subset expansion, altered cytokine networks, and autoantibody-mediated injury.
• Diverse OirAE phenotypes include uveitis, ocular surface disease, optic neuritis, and retinopathy.

Conclusions:

• Understanding ICI-induced immune dysregulation is crucial for diagnosing and managing OirAEs.
• A consensus-based, mechanism-informed approach is needed to balance visual preservation and anti-tumor immunity.
• Management involves individualized strategies including corticosteroids, immunosuppression, and biologics.