Ocular immune-related adverse events with immune checkpoint inhibitors: A retrospective cohort study

Background Immune checkpoint inhibitors (ICIs) are widely used to treat a variety of malignancies. Ocular immune-related adverse events (irAEs) have been increasingly recognized as rare side effects of these medications. Methods We performed a retrospective study of ocular irAEs at our institution between 2017 and 2025. Ophthalmic and oncologic data were extracted, and visual acuity was compared before, during, and after events. Results Nineteen ocular irAEs occurred in 17 patients. Melanoma and pembrolizumab were the most common type of malignancy and ICI, respectively. Most events were low grade (78.9%), with uveitis being the most common (36.8%). Ocular irAEs developed after a mean of 3.6 ± 3.2 cycles (155 ± 191 days) of ICI treatment. Best-corrected visual acuity (BCVA) declined significantly during events from 0.06 ± 0.12 logMAR (20/23) to 0.22 ± 0.30 logMAR (20/33) (p = 0.011). There was no significant difference between BCVA at baseline and after irAE treatment. Resolution of the ocular irAE occurred in 78.9% of patients. Conclusions Ocular events tended to occur soon after ICI initiation; however, time to onset varied. Most patients responded well to treatment and experienced resolution of the ocular event. ICI discontinuation may be necessary for severe ocular adverse events. Close collaboration between ophthalmologists and oncologists is essential when managing ocular irAEs.