Purpose: We report the two cases of Vogt-Koyanagi-Harada disease-like uveitis following systemic treatment with pembrolizumab. Pembrolizumab is a newer generation of the anti-programmed cell death-1 monoclonal antibodies that was recently approved in Japan, and frequently administrated for the treatment of various carcinoma.
Case 1: A 65-year-old female presented with blurred vision in both eyes and ocular pain in the left eye during 6-terms of pembrolizumab for the treatment of bladder cancer. Slit lamp examination showed inflammatory cells and fibrin formation in the anterior chamber, posterior synechiae and cataract in both eyes. Fluorescein angiography showed hyperfluorescence of the optic disc. Optical coherence tomography showed fold of choroid. Visual acuity was (0.2) in the right eye and (0.02) in the left eye. Pembrolizumab was stopped according to guideline. After topical and oral corticosteroid therapy administration, the uveitis was subsided, visual acuity was improved to (0.5) in the both eyes. Final visual acuity was improved to (1.0) in the both eyes after cataract surgery. Human leucocyte antigen (HLA) typing was positive to DR-4.
Case 2: A 92-year-old male presented with blurred vision in both eyes during 3-terms of pembrolizumab for the treatment of bladder cancer. Slit lamp examination showed inflammatory cells in the anterior chamber and serous retinal detachment in both eyes. Visual acuity was (0.6) in the right eye and (0.5) in the left eye. Pembrolizumab was stopped according to guideline. After sub-Tenon triamcinolone acetonide injection, serous detachment was diminished, visual acuity was improved. HLA typing was positive to DR-4.
Conclusions: We report the two cases of Vogt-Koyanagi-Harada disease-like uveitis associated with pembrolizumab. Ophthalmologists should keep in mind the possibility of developing uveitis associated with immune check point inhibitor.
Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc) 124: 1003-1012, 2020.