Immunotherapy and targeted therapy for metastatic cancer may cause immune-related adverse events such as uveitis. If these adverse effects are severe or require systemic steroids, cancer therapy is often held or discontinued. Researchers at the Cleveland Clinic Foundation demonstrated that local steroid therapy effectively managed cancer therapy–associated uveitis, allowing patients to continue their cancer treatment.

Their retrospective case series analyzed five patients. Two presented with anterior uveitis, two with panuveitis and one with posterior uveitis. Time to uveitis onset following cancer therapy initiation was three to 12 months. Four of five patients demonstrated evidence of posterior segment inflammation on multimodal imaging.

Topical prednisolone acetate 1% alone successfully treated the anterior uveitis. For those with posterior segment involvement not responsive to prednisolone acetate, the team successfully treated them with topical difluprednate, intravitreal triamcinolone acetonide or a combination. Patients with isolated anterior uveitis did not require maintenance topical therapy, and those with posterior and panuveitis required chronic low-dose topical therapy.

The researchers suggest starting with topical steroids and initiating injectable steroids in cases of recalcitrant panuveitis or posterior uveitis. Subclinical inflammation, seen on posterior segment imaging, responds robustly to difluprednate or intravitreal steroid therapy, they found. Patients with posterior segment involvement may require more aggressive management and long-term maintenance, the researchers conclude in the study.

Venkat AG, Arepalli S, Sharma S, et al. Local therapy for cancer therapy-associated uveitis: a case series and review of the literature. Br J Ophthalmol. August 13, 2019. [Epub ahead of print].