Delayed inflammatory chorioretinopathy with VKH-like features and bilateral choroidal neovascularization after nivolumab-ipilimumab dual checkpoint blockade for metastatic melanoma.

Abstract

This case describes a delayed bilateral posterior pole inflammation with secondary choroidal neovascularization (CNV) occurring after discontinuation of dual immune checkpoint inhibition (ICI) for metastatic cutaneous melanoma. A 53-year-old man presented with sudden visual loss five months after his last ICI infusion. Although symptoms were initially unilateral, fundus examination and multimodal imaging revealed bilateral posterior pole involvement, with an active CNV and retinal pigment epithelium (RPE) disturbances in both eyes. Intravitreal anti-vascular endothelial growth factor (anti-VEGF) monotherapy in one eye and corticosteroid monotherapy in the other provided limited benefit. Combined therapy achieved partial anatomical improvement but limited functional visual recovery, particularly in the initially symptomatic eye. In conclusion, this case highlights that ICI-associated inflammatory chorioretinopathy with VKH-like features may present late and progress despite treatment discontinuation, underscoring the role of multimodal imaging in guiding targeted management.