Sunset Glow Fundus and Bilateral Choroidal Neovascularization in a Pediatric Patient Receiving Nivolumab: A Rare Pediatric Immune-Related Ocular Complication.

PURPOSE: To report a rare case of immune checkpoint inhibitor (ICI)- associated bilateral choroidal neovascularization (CNV) and sunset glow fundus appearance in a pediatric patient receiving long-term nivolumab therapy.

METHOD: Observational case report.

CASE REPORT: A 15-year-old male with metastatic myoepithelial carcinoma, on nivolumab for 2.5 years, presented with bilateral blurred vision. Fundus examination revealed a sunset glow fundus, punched-out lesions, and CNV in both eyes. Optical coherence tomography (OCT) confirmed inflammatory CNV with choroidal thickening. Nivolumab was discontinued, and the patient received systemic corticosteroids and intravitreal ranibizumab. Despite initial improvement, CNV recurred upon steroid tapering, requiring additional anti-VEGF injections. At four months, vision stabilized with no CNV reactivation.

CONCLUSION

This case represents the first pediatric report of ICI- associated bilateral CNV and sunset glow fundus appearance. It underscores the importance of monitoring for late-onset immune-related ocular complications in patients on long-term nivolumab therapy.