Ocular Findings on Patients after Anti-PD-1/PD-L1 Antibodies Treatment: A Prospective Observation Report, A Pilot Study

Abstract

Purpose: Immune Checkpoint Inhibitors (ICIs) cause ICI-related adverse events (irAEs) such as dry eye and uveitis, which can be severe, sometimes necessitating the suspension of ICI treatment. Retrospective studies have targeted ocular irAEs which can detect only moderate to severe symptomatic uveitis. To the best of our knowledge, this is the first prospective study on ocular irAEs. We aimed to investigate symptomatic and subclinical ocular changes in ICI-treated eyes, to identify early changes in ocular irAE and control conditions without suspending ICI treatment.

Methods: 22 participants who began ICI treatment between July 2020 and July 2021 in Keiyu Hospital, Japan (3 women and 19 men; age, 69.1 ± 7.9 years, range, 53–83 years) were prospectively evaluated. The patients underwent ocular examinations before and 1, 3, and every 2 months after the initial dose of ICI. Examinations included measurement of best-corrected visual acuity, fundus biomicroscopy, spectral domain Optical Coherence Tomography (OCT) and aqueous flare. Central choroidal thickness (CCT) was measured using OCT.

Results: Among the 22 participants, 6 developed systemic irAEs. Of these 6 patients, one experienced ocular pain after ICI treatment, likely due to dry eye disease. We did not observe any change in CCT or aqueous flare, even in patients with systemic AEs. We were unable to ascertain whether CCT or aqueous flare are valuable clues for the early identification of ocular irAEs. We continue this prospective study with a larger sample size.

Conclusions: Systemic irAEs are not necessarily accompanied by ophthalmological changes.