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Cornea. 2016 Mar;35(3):399-401. doi: 10.1097/ICO.0000000000000724.

Cyclosporine for Dry Eye Associated With Nivolumab: A Case Progressing to Corneal Perforation.

Author information

1
*Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, CT; and †Department of Internal Medicine, Yale School of Medicine, Smilow Cancer Hospital at Yale-New Haven Hospital, New Haven, CT.

Abstract

PURPOSE:

To present the clinical outcome of 2 cases of severe dry eye associated with Nivolumab, with 1 case progressing to corneal perforation.

DESIGN:

Case report.

CASE 1:

: A 58-year-old man with metastatic melanoma was referred for the management of severe bilateral dry eyes after undergoing his sixth cycle of Nivolumab. The right eye progressed to corneal perforation 4 weeks after referral, after which Nivolumab was discontinued. When metastatic disease recurred, Nivolumab was continued with an ocular surface stabilized with an intensive regimen that included topical cyclosporine.

CASE 2:

: A 46-year-old woman with metastatic melanoma was referred for severe dry eye symptoms around the timing of her third cycle of Nivolumab. Improvement of symptoms and surface staining was achieved with a regimen that included aggressive lubrication and topical cyclosporine. On follow-up after completing Nivolumab therapy, metastatic melanoma has remained regressed.

CONCLUSIONS:

Nivolumab can cause or worsen dry eye disease to the point of corneal perforation. Given that its antitumor effect is immune-mediated, therapies targeting ocular surface inflammation can be effective for stabilizing dry eye disease in patients who continue treatment with Nivolumab.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT01024231.

PMID:
26771550
DOI:
10.1097/ICO.0000000000000724
[Indexed for MEDLINE]

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