Ocular immunology and inflammation · 2026
Immune Checkpoint Inhibitor-Associated Uveitis Treated with the 0.19 Mg Fluocinolone Acetonide Intravitreal Implant: Clinical Outcomes in a Retrospective Case-Series.
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Llorenç Víctor, Miserocchi Elisabetta, Fonseca Cristina, Pleyer Uwe
Аннотация
PURPOSE: To evaluate the effectiveness and safety of the 0.19 mg fluocinolone acetonide (FAc) intravitreal implant for the management of immune checkpoint inhibitor (ICI)-associated uveitis.
METHODS: Multicenter retrospective case-series including patients who developed uveitis during ICI therapy and were treated with a 0.19 mg FAc implant. The primary outcome was complete resolution of intraocular inflammation at the last follow-up visit (LFUV). Secondary outcomes included changes in best-reported visual acuity (BRVA), central retinal thickness (CRT), anterior chamber cell (ACC) and flare grades, vitreous haze (VH), intraocular pressure (IOP), need for adjunctive anti-inflammatory therapy, and modifications in ICI treatment.
RESULTS: Fourteen eyes of 9 patients (mean age 60.0 ± 8.0 years) were included. Median time from ICI initiation to uveitis onset was 5.0 months (interquartile range [IQR]: 2.0-6.0). Median follow-up after FAc implantation was 15.0 months (IQR: 12.0-18.0). At LFUV, complete inflammatory resolution was achieved in 92.9% of eyes, significantly higher than pre-implant status (p = 0.0039). BRVA improved significantly from uveitis onset (0.79 ± 0.17 logMAR) to last follow-up (0.19 ± 0.04 logMAR; p = 0.0008). ACC, flare, and VH resolved in all eyes (p < 0.001 for all comparisons). IOP remained stable, with one transient elevation successfully controlled with topical therapy. Requirement for adjunctive anti-inflammatory treatment declined progressively after implantation. Most patients were able to continue or resume ICI therapy during follow-up.
CONCLUSIONS: The 0.19 mg FAc intravitreal implant provided sustained control of inflammation, significant visual improvement, and reduced treatment burden in patients with ICI-associated uveitis. This local therapeutic approach may facilitate continuation of systemic immunotherapy while maintaining ocular disease control.
METHODS: Multicenter retrospective case-series including patients who developed uveitis during ICI therapy and were treated with a 0.19 mg FAc implant. The primary outcome was complete resolution of intraocular inflammation at the last follow-up visit (LFUV). Secondary outcomes included changes in best-reported visual acuity (BRVA), central retinal thickness (CRT), anterior chamber cell (ACC) and flare grades, vitreous haze (VH), intraocular pressure (IOP), need for adjunctive anti-inflammatory therapy, and modifications in ICI treatment.
RESULTS: Fourteen eyes of 9 patients (mean age 60.0 ± 8.0 years) were included. Median time from ICI initiation to uveitis onset was 5.0 months (interquartile range [IQR]: 2.0-6.0). Median follow-up after FAc implantation was 15.0 months (IQR: 12.0-18.0). At LFUV, complete inflammatory resolution was achieved in 92.9% of eyes, significantly higher than pre-implant status (p = 0.0039). BRVA improved significantly from uveitis onset (0.79 ± 0.17 logMAR) to last follow-up (0.19 ± 0.04 logMAR; p = 0.0008). ACC, flare, and VH resolved in all eyes (p < 0.001 for all comparisons). IOP remained stable, with one transient elevation successfully controlled with topical therapy. Requirement for adjunctive anti-inflammatory treatment declined progressively after implantation. Most patients were able to continue or resume ICI therapy during follow-up.
CONCLUSIONS: The 0.19 mg FAc intravitreal implant provided sustained control of inflammation, significant visual improvement, and reduced treatment burden in patients with ICI-associated uveitis. This local therapeutic approach may facilitate continuation of systemic immunotherapy while maintaining ocular disease control.