PEMBROLIZUMAB-RELATED BILATERAL OCULAR HYPOTONY ASSOCIATED WITH CILIARY DETACHMENTS AND MACULAR EDEMA: A TREATMENT-RESISTANT SIDE EFFECT.

PURPOSE: The aim of this study was to report a case of bilateral ocular hypotony associated with ciliary detachments and macular edema as an uncommon troublesome side effect of pembrolizumab (an immune checkpoint inhibitor) treatment.

METHODS

A 56-year-old man with a history of metastatic axillary melanoma (bone, lung, spleen, and lymph node lesions) treated with pembrolizumab complained of visual deterioration at his first-year anti-programmed-cell death-1 follow-up visit. VA in both eyes was 20/32. The patient presented with bilateral ocular hypotony (7 mmHg in the right eye and 3 mmHg in the left eye), ciliary detachments, and macular edema. Several treatments were sequentially tried, including systemic steroid therapy, subconjunctival injections of triamcinolone, an intravitreal dexamethasone implant, and leaving some cohesive viscoelastic agent during cataract surgery.

RESULTS

None of the treatments tried were effective in reducing the ocular hypotony, and stopping pembrolizumab was not an option due to its efficacy in controlling the cancer.

CONCLUSION

Pembrolizumab treatment carries a risk of ocular hypotony which can be bilateral, presenting a challenging risk-benefit dilemma, particularly if pembrolizumab is effective in controlling the cancer.