Long-Term Follow-Up of Checkpoint Inhibitor-Associated Uveitis Treated with Fluocinolone Acetonide Intravitreal Implant in a Pediatric Patient.

Abstract

Purpose: To describe the clinical course and 2-year follow-up of a pediatric patient treated with 0.18 mg fluocinolone acetonide intravitreal implants (Yutiq, EyePoint Pharmaceuticals) for chronic, bilateral immune checkpoint inhibitor (ICI)-associated uveitis.

Methods: Retrospective case report.

Results: A 15-year-old female patient with advanced epithelioid peritoneal mesothelioma on pembrolizumab and ipilimumab therapy developed chronic, bilateral ICI-associated anterior and intermediate uveitis failing topical corticosteroids was treated with bilateral intravitreal 0.18 mg fluocinolone acetonide implants, avoiding systemic immunosuppression. One year later, severe steroid-induced ocular hypertension (IOP) OS developed after receiving high-dose systemic corticosteroids for life-threatening ICI-related rhabdomyolysis. Goniotomy controlled IOP, and cataract extraction 3 months later led to visual recovery.

Conclusion: The intravitreal fluocinolone acetonide 0.18 mg implant may be an effective treatment for recalcitrant ICI-associated intermediate uveitis in the pediatric population, providing long-term control of inflammation while preserving immunotherapy effectiveness. Careful follow-up is needed to monitor for complications of uveitis and corticosteroid treatment.