Longitudinal Outcomes in Immune Checkpoint Inhibitor-Associated Uveitis

To characterize clinical features and longitudinal outcomes in eyes with immune checkpoint inhibitor (ICI)-associated uveitis.

Retrospective cohort study at a tertiary academic center (2015-2024). Eyes developing uveitis after ICI initiation were identified using ICD-9/10 codes and chart review. Baseline and final follow-up anatomic location of uveitis, SUN grades of inflammation, best-corrected visual acuity (BCVA) in logMAR, intraocular pressure, and treatment were collected.

Among 5,966 patients, 29 (50 eyes; 0.49%) developed uveitis, bilateral in 21 (72.4%). Most associated agents were pembrolizumab (27 patients, 93.1%), nivolumab (19, 65.5%), and ipilimumab (9, 31.0%). Anterior uveitis occurred in 22 patients (75.9%), posterior uveitis in 2 (6.9%), and panuveitis in 5 (17.2%); cystoid macular edema in 11 (37.9%). Median follow-up was 438 days (IQR: 101-921). Topical corticosteroids were used in 23 patients (79.3%) and intravitreal corticosteroid implants in 3 (10.3%). Baseline BCVA was ≤ 0.3 logMAR in 21/50 eyes (42.0%) and ≥1.0 in 8/50 (16.0%). Anterior chamber cells ≥ 1+ were present in 32/50 (64.0%), flare ≥ 1+ in 10/50 (20.0%), anterior vitreous cells ≥ 1+ in 11/50 (22.0%), and vitreous haze ≥ 1+ in 7/50 (14.0%). At final follow-up, BCVA ≤ 0.3 logMAR increased to 33/50 (66.0%) while 7/50 (14.0%) worsened to ≥1.0; median logMAR was 0.36 at baseline and 0.18 at final follow-up overall, without a statistically significant change. Anatomic subgroups also did not have statistically significant changes.

ICI-associated uveitis often involved clinically significant inflammation and reduced vision. When promptly recognized and managed with appropriate therapy and close follow-up, long-term visual acuity was generally stable.