Zhang Huixin Anna, Yuan Amelia T, Chiasson Noémie, Wu Kevin Y, Kalevar Ananda
Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada.
Faculty of Medicine, Université Laval, Quebec, QC, Canada.
J Ophthalmic Inflamm Infect. 2025 May 12;15(1):44. doi: 10.1186/s12348-025-00484-8.
Vogt-Koyanagi-Harada (VKH)-like uveitis is uniquely reported with immune checkpoint inhibitors (ICI) and BRAF/MEK inhibitors. This article aims to provide a comprehensive portrait of the comorbidities, ocular presentations, treatments, and visual outcomes of patients with VKH-like uveitis following ICI therapy.
ICIs are increasingly used in cancer therapy, but poorly understood ocular immune-related adverse events (irAEs) can lead to suspension of treatment and be vision-threatening.
We conducted a systematic review (PROSPERO #CRD42024558269) according to PRISMA guidelines. MEDLINE, Embase, CENTRAL, and Web of Science were searched for English articles published up to June 28, 2024. All study designs reporting on incident VKH-like uveitis following ICI were included. Risk of Bias was assessed using a tool modified from Murad et al. (2018).
Of 865 articles, we included 42 articles (4 observational studies, 28 case reports, 6 case series, 3 letters, and 1 editorial) from 12 countries, comprising 52 patients. The mean age was 60.0 ± 11.9 years, and 32 (61.5%) were females. Thirty-six (69.2%) had melanoma, and most were undergoing treatment with a PD-1 inhibitor alone (n = 33, 63.5%) or in combination with a CTLA-4 inhibitor (n = 10, 19.2%). The mean duration of ICI treatment before VKH-like uveitis symptoms was 22.2 ± 29.6 weeks, and the mean duration of ocular symptoms was 16.7 ± 18.6 weeks, with wide variation. Overall, 43 patients (73.1%) had imaging or exams suggesting bilateral involvement and 21 cases (40.4%) suggesting panuveitis. Only 31 cases (59.6%) met the acute initial-onset uveitis criteria, and 15 (28.8%) met the chronic phase criteria. Most (n = 47, 90.4%) required systemic or intravitreal steroids, termination of ICI (n = 31, 59.6%), and experienced full resolution or remission of visual symptoms (n = 43, 82.7%). Most articles (n = 40, 95.2%) were judged to be at medium risk of bias.
This descriptive systematic review consisted mostly of case reports, but it confirmed that a high proportion of VKH-like uveitis occur with PD-1 inhibitors and melanoma patients. VKH-like uveitis can lead to suspension of treatment. Further collaboration between oncologists and ophthalmologists is needed in the continuum of cancer care.
Vogt-小柳-原田（VKH）样葡萄膜炎是免疫检查点抑制剂（ICI）和BRAF/MEK抑制剂特有的报告病症。本文旨在全面描述ICI治疗后VKH样葡萄膜炎患者的合并症、眼部表现、治疗方法和视觉预后。
ICI在癌症治疗中的应用越来越广泛，但对眼部免疫相关不良事件（irAEs）的了解不足可能导致治疗中断并威胁视力。
我们根据PRISMA指南进行了一项系统评价（PROSPERO编号#CRD42024558269）。检索了MEDLINE、Embase、CENTRAL和科学网，查找截至2024年6月28日发表的英文文章。纳入所有报告ICI治疗后发生VKH样葡萄膜炎的研究设计。使用从Murad等人（2018年）修改而来的工具评估偏倚风险。
在865篇文章中，我们纳入了来自12个国家的42篇文章（4项观察性研究、28篇病例报告、6个病例系列、3封信函和1篇社论），共52例患者。平均年龄为60.0±11.9岁；32例（61.5%）为女性。36例（69.2%）患有黑色素瘤，大多数仅接受PD-1抑制剂治疗（n=33，63.5%）或与CTLA-4抑制剂联合治疗（n=10，19.2%）。VKH样葡萄膜炎症状出现前ICI治疗的平均持续时间为22.2±29.6周，眼部症状的平均持续时间为16.7±18.6周，差异较大。总体而言，43例患者（73.1%）的影像学检查或眼部检查提示双侧受累，21例（40.4%）提示全葡萄膜炎。只有31例（59.6%）符合急性初发性葡萄膜炎标准，15例（28.8%）符合慢性期标准。大多数患者（n=47，90.4%）需要全身或玻璃体内注射类固醇，终止ICI治疗（n=31，59.6%），视觉症状完全缓解或减轻（n=43，82.7%）。大多数文章（n=40，95.2%）被判定为中度偏倚风险。
这项描述性系统评价主要由病例报告组成，但证实了高比例的VKH样葡萄膜炎发生在使用PD-1抑制剂的黑色素瘤患者中。VKH样葡萄膜炎可导致治疗中断。在癌症治疗的连续过程中，肿瘤学家和眼科医生需要进一步合作。
