Radiol Oncol 2022; 56(2): 129-137. doi: 10.2478/raon-2022-0007
129
review article
Various clinical presentations of uveitis 
associated with durvalumab treatment 
Nika Vrabic1, Ana Fakin1, Polona Jaki Mekjavic1,2,3, Urska Janzic4, Martina Vrankar5,  
Natasa Vidovic Valentincic1,2
1 University Eye Clinic, University Clinical Centre Ljubljana, Slovenia
2 Faculty of Medicine, University of Ljubljana, Slovenia
3 Jožef Stefan Institute, Ljubljana, Slovenia
4 University Clinic of Pulmonary and Allergic Diseases Golnik, Slovenia
5 Institute of Oncology Ljubljana, Ljubljana, Slovenia
Radiol Oncol 2022; 56(2): 129-137.
Received 24 November 2021 Accepted 10 January 2022
Correspondence to: Nika Vrabič, M.D., University Eye Clinic, University Clinical Centre Ljubljana, Grablovičeva ulica 46, SI-1000 Ljubljana, 
Slovenia. E-mail: vrabicnika@gmail.com
Disclosure: No potential conflicts of interest were disclosed. 
This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Background. Immune checkpoint inhibitors (ICI) are becoming increasingly common in treating several cancer 
types. Durvalumab is a human IgG1 monoclonal antibody that blocks PD-L1 binding to PD-1 and CD80 and has re-
cently been approved for the treatment of extensive-stage small-cell lung cancer (ES-SCLC) and locally advanced 
unresectable (NSCLC). The present review aimed to analyse immune-mediated uveitis, secondary to durvalumab 
treatment, through a review of the literature and a presentation of two clinical cases.
Patients and methods. A literature review using PubMed search was conducted to identify cases of uveitis sec-
ondary to durvalumab and cases of uveitis with optic disc oedema secondary to ICI use that were reported prior to 
November 14, 2021. Additionally, we report two cases of uveitis consequent on durvalumab treatment. 
Results. Five cases of uveitis secondary to durvalumab use were identified in the literature. Anterior, posterior uvei-
tis and vasculitis were reported. Additionally, we present a case of bilateral intermediate uveitis with bilateral optic 
disc oedema and a case of bilateral posterior uveitis. Our further search revealed 12 cases of uveitis with optic disc 
oedema secondary to ICI use, with the majority of cases reported secondary to PD-1 inhibitors. 
Conclusions. Rarely reported, uveitis secondary to durvalumab can present various clinical pictures and requires a 
thorough diagnostic workup. Once the diagnosis is established, treatment, commonly with a local or systemic corti-
costeroid, should be adapted to the severity of the inflammation.
Key words: durvalumab, uveitis, optic disc oedema, immune checkpoint inhibitor, adverse effects
Introduction
Durvalumab is a human monoclonal antibody 
belonging to immune checkpoint inhibitors (ICI) 
group. It is registered for the treatment of extensive-
stage small-cell lung cancer (ES-SCLC) and locally 
advanced unresectable non-small cell lung cancer 
(NSCLC).1,2 Interaction of programmed death-li-
gand 1 (PD-L1) expressed on the surface of cancer 
cells with programmed cell death protein 1 (PD-1) 
and the cluster of differentiation 80 (CD80) mole-
cules expressed on the surface of T-cells results in 
inhibition of T-cell activation. By selectively block-
ing PD-L1/PD-1 and PD-L1/CD80 interactions, dur-
valumab increases the likelihood of immunologic 
attack and destruction of cancer cells.3 Under nor-
mal conditions, PD-L1/PD-1 interaction is involved 
in maintaining immune tolerance to self-antigens.4 
Blocking PD-L1 interactions durvalumab thus not 
only facilitates the destruction of cancerous cells 
Radiol Oncol 2022; 56(2): 129-137.
Vrabic N et al. / Uveitis associated with durvalumab130
but also induces various immune-mediated ad-
verse effects.2,5 The present review aimed to analyse 
immune-mediated uveitis, secondary to durvalum-
ab treatment, through a review of the literature and 
a presentation of two additional clinical cases.
Methods 
Published cases of inflammatory eye conditions 
secondary to treatment with durvalumab were 
collected through a literature search on PubMed, 
using the following search terms: ’’durvalumab’’, 
’’eye’’, ’’uveitis’’, ’’inflammation’’. Moreover, pub-
lished cases of optic disc oedema with uveitis 
secondary to immune checkpoint inhibitors were 
collected with PubMed search, using the follow-
ing search terms: ’’uveitis’’, ‘’immune checkpoint 
inhibitor/s’’, ’’optic disc oedema’’, ’’papillitis’’. 
Only papers accessible in the English language 
were included. 
Additionally, we report two cases of uveitis sec-
ondary to durvalumab treatment that presented to 
our clinic. Clinical report adhered to the general 
principles outlined in the Declaration of Helsinki. 
Informed consent was obtained from the patients.
Results
Uveitis secondary to durvalumab
Numerous cases of uveitis have been described as 
consequent on the immune checkpoint inhibitors5-15, 
with only a few occurring secondary to durvalumab 
treatment.6-8 This is likely due to both: fewer patients 
treated with durvalumab in proportion to the other 
immune checkpoint inhibitors6,16 and more frequent 
and severe side effects of cytotoxic T lymphocyte-
associated protein 4 (CTLA-4) inhibitors compared 
to the PD-1 and PD-L1 inhibitors.6
Our search, described in the Methods above, 
yielded five reports of uveitis secondary to dur-
valumab treatment. Additionally, two patients 
presented to our clinic between November 2020 
and March 2021 and are added in Table 1. The 
clinical presentation varies – anterior, intermedi-
ate, posterior uveitis, and retinal vasculitis have 
been described and were managed with a local or a 
systemic steroid. Immune checkpoint inhibitor was 
discontinued in four out of seven (57%) cases. 
Other inflammatory eye conditions 
secondary to durvalumab
Although rare, various other immune-mediated 
ocular adverse effects have been linked with dur-
valumab. Carrera reported a drug-induced myopa-
thy of extraocular muscles in a patient treated with 
durvalumab and tremelimumab.17 Optic neuropa-
thy with disc oedema has been described as sec-
ondary to durvalumab use by Noble et al.18 Drug-
induced Graves’ orbitopathy has been observed in a 
patient treated with tremelimumab and durvalum-
ab.19 Moreover, in one of the largest reviews of da-
tabases of ocular adverse events in patients treated 
with PD-1/PD-L1 inhibitors, Young et al. recently 
reported two cases of serious ocular adverse events, 
with no data on the ocular diagnosis available.16
Patients
We report two cases of uveitis secondary to dur-
valumab treatment. The first patient is a 57-year-old 
female who presented to our clinic in November 
2020 with a one-month history of blurred vision 
and floaters. Due to ES-SCLC the patient was treat-
ed with four cycles of combined chemo-immu-
notherapy with carboplatin, etoposide, and dur-
valumab, starting in April 2020 and then continued 
maintenance durvalumab treatment, receiving a 
total of eight cycles by November 2020. Both clini-
cal and radiological remissions were achieved. She 
presented to our clinic after having received the 
TABLE 1. Published cases reporting uveitis secondary to durvalumab (PD-L1 inhibitor) treatment
Author, year
Number 
of cases 
reported
Indication Ocular inflammation specification (% eyes) Treatment
Discontinuing immune 
checkpoint inhibitor
Dow et al. 20206 3 n/a Anterior uveitis 80%Posterior uveitis 20%
Local corticosteroid
Systemic corticosteroid No
Parikh et al., 20207 1 Non-small cell lung cancer Anterior uveitis Local corticosteroid Yes
Andrade et al., 20208 1 Non-small cell lung cancer Retinal vasculitis Systemic corticosteroid Yes
Vrabic et al., 2021 2
Small cell lung 
cancer, non-small 
cell lung cancer
Intermediate uveitis, 
Posterior uveitis Systemic corticosteroid Yes
Radiol Oncol 2022; 56(2): 129-137.
Vrabic N et al. / Uveitis associated with durvalumab 131
eighth cycle of durvalumab. Her other past medi-
cal and ocular history was unremarkable.
Ophthalmic examination revealed aqueous cells 
1+ and vitreous cells 1+ as well as bilateral oedema 
of the optic discs (Figure 1). The best-corrected 
decimal visual acuity (BCVA) was 0.7 and 0.8 p. for 
the right and left eye, respectively.
Bilateral optic nerve drusen were revealed on 
fundus autofluorescence (FAF) and confirmed on 
ocular ultrasound and optical coherence tomog-
raphy (OCT) (Figure 2). Fluorescein angiography 
(FA) was performed (Figure 3), and a diagnosis 
of intermediate uveitis was made with optic disc 
drusen as an incidental finding.
No signs of intracranial hypertension were re-
vealed on MRI, nor did it show clear signs of in-
tracranial metastasis or other abnormalities in the 
course of the optic nerves. After excluding other 
common uveitic aetiologies (Supplementary File 1. 
Supplementary Table 1), the ocular inflammation 
was thought to be consequent to durvalumab treat-
ment. The patient was treated with three applica-
tions of intravenous methylprednisolone, receiv-
ing 500 mg per day and continued with 48 mg of 
oral methylprednisolone per day. The dose was 
then tapered over six weeks. Monthly maintenance 
treatment with durvalumab was discontinued not 
only due to uveitic reaction but also due to the pro-
gression of the disease.
We observed stable best-corrected visual acuity 
(BCVA) of the left eye on a five-week follow-up, and 
a slight improvement of BCVA of the right eye. On 
ophthalmoscopy, diminishment of inflammation 
was observed with clear anterior chambers and vit-
reous cells 0.5 +. In addition, decreased swelling of 
the optic discs was noted (Figure 4). 
The second case was a 55-year old female, sent 
to our clinic in March 2021 for a complaint of blur-
ry vision that she first noted one week prior to con-
sulting. Her past medical history was significant 
for K-RAS positive adenocarcinoma in the right 
middle pulmonary lobe, diagnosed in 2019. She 
was treated with concurrent radical chemo-radio-
therapy. Clinical and radiological remissions were 
achieved. She then continued with immunothera-
py and received 26 applications of durvalumab in 
the period between January 2020 and January 2021.
The patient had been previously seen at our 
clinic eight years prior due to peripheral pigment-
ed retinal changes, which were at that time thought 
to be extensive retinal pigment epithelium (RPE) 
hypertrophy and small choroidal nevi (Figure 5A). 
Follow-up was advised, but the patient failed to 
present for further check-ups.
FIGURE 1. Case I. Fundoscopy, at presentation, on one-week and five-week follow-
up. Follow-up images show diminishment of vitreous haze and regression of optic 
disc swelling.
OD(R) = oculus dexter (right); OS(L) = oculus sinister (left)
FIGURE 2. Case I. Optical coherence tomography (OCT) of optic discs. Optic disc 
drusen at presentation and on a five-week follow-up. No alteration in optic disc 
drusen size is visible. Up images show diminishment of vitreous haze and regression 
of optic disc swelling.
OD(R) = oculus dexter (right); OS(L) = oculus sinister (left)
Radiol Oncol 2022; 56(2): 129-137.
Vrabic N et al. / Uveitis associated with durvalumab132
In March 2021, the patient was diagnosed with 
bilateral iridocyclitis and prescribed corticosteroid 
and nonsteroid anti-inflammatory eye drops with 
the addition of a systemic corticosteroid, 8 mg of 
oral methylprednisolone daily. By her first consul-
tation at our clinic six days later, her initial BCVA 
of 0.6 in the right and 0.4 in the left eye improved to 
0.7 p. and 1.0, respectively. Slit-lamp examination 
revealed bilateral aqueous cells 1+ and vitreous 
cells 2+, blurred papillary margins, and multiple 
flat, grey-white lesions on the posterior pole with 
macular and peripapillary predilection (Figure 5B). 
Hypofluorescent areas in the peripapillary and 
macular region on indocyanine-green angiography 
(ICGA) corresponded to the areas of ellipsoid zone 
loss on OCT (Figure 6A, Figure 7). The patient was 
diagnosed with bilateral posterior uveitis.
Laboratory and radiological workups were 
performed to exclude common causes of uveitis 
(Supplementary File 1. Supplementary Table 2). CT 
scan of the thorax revealed no progress of the lung 
cancer, nor did CT scan of the head and ultrasound 
of the orbits show signs of cranial or orbital metas-
tasis.
Bilateral posterior uveitis was then considered 
most likely secondary to durvalumab. The patient 
was treated with 500 mg of intravenous methyl-
prednisolone daily for three consecutive days. She 
continued with 48 mg of oral methylprednisolone 
daily, tapered over four weeks until the mainte-
nance dose of 12 mg of oral methylprednisolone 
per day was reached. 
On a three-week follow-up, amelioration of 
right eye BCVA (0.9) and stable left eye BCVA (1.0 
p.) was observed. No aqueous cells were detected 
while vitreous exudation with cells 1+ in the right 
and 2+ in the left eye remained without clear dy-
namics. Diminishment of grey-white lesions on 
the posterior pole was observed on fundoscopy 
(Figure 5C) and FAF revealed hyperautofluores-
cent spots (Figure 8). Due to the current remission 
of the pulmonary disease, treatment with dur-
valumab is not foreseen in the near future regard-
less of the uveitic reaction. 
Uveitis with optic disc oedema 
secondary to immune checkpoint 
inhibitor treatment
While posterior uveitis secondary to durvalumab 
has been previously reported6, the constellation of 
uveitis and optic disc oedema consequently to dur-
valumab treatment has been, to our knowledge, 
described here for the first time. Uveitis with ei-
FIGURE 3. Case I. Fluorescein angiography at presentation. Early and 
late frames. Contrast blockage in the upper temporal part of the right 
optic disc (white arrow), corresponding to a peripapillary haemorrhage. 
Hypofluorescent dots (black arrow) corresponded to hyperreflective 
spots on optical coherence tomography (OCT). Fluorescein angiography 
five weeks on methylprednisolone treatment. Early and late frames. 
Diminishment of the contrast blockage in the upper temporal part 
of the right optic disc (white arrow) corresponding to a peripapillary 
haemorrhage. Hypofluorescent dots (black arrow) are less prominent.
OD(R) = oculus dexter (right); OS(L) = oculus sinister (left)
Radiol Oncol 2022; 56(2): 129-137.
Vrabic N et al. / Uveitis associated with durvalumab 133
ther optic disc oedema or papillitis was previously 
linked with the use of other ICIs (Table 2). Even 
though CTLA-4 inhibitors are deemed to cause 
more frequent and severe inflammatory ocular side 
effects than PD-1, and PD-L1 inhibitors6, most pub-
lished cases of uveitis with optic disc oedema or 
papillitis were secondary to a PD-1 inhibitor (85%), 
with only one case following the use of CTLA-4 in-
hibitor. In 7 patients (53%), optic disc oedema oc-
curred with panuveitis. In 5 patients (39%), signs 
of anterior uveitis with or without vitreous exuda-
tion were present, and in 1 patient (8%) optic disc 
oedema occurred with posterior uveitis and vascu-
litis. Systemic steroid (with or without a local ster-
oid) was the treatment of choice in 69%, while 31% 
patients were managed with a local steroid only. 
Only one case was reported not discontinuing the 
ICI treatment.
Discussion
A plausible explanation for durvalumab-induced 
uveitis, one of the most commonly reported oph-
FIGURE 4. Case I. Optical coherence tomography (OCT) of optic discs, at presentation, one week on methylprednisolone 
treatment, five weeks on methylprednisolone treatment. Follow-up shows regression of optic disc swelling.
OD(R) = oculus dexter (right); OS(L) = oculus sinister (left)
Radiol Oncol 2022; 56(2): 129-137.
Vrabic N et al. / Uveitis associated with durvalumab134
thalmic complications linked with the durvalumab 
use2, lies in the proposed constitutive expression of 
PD-L1 receptor by the eye tissue.20 PD-L1 receptor 
was found near the blood-ocular barriers, includ-
ing corneal epithelium, corneal endothelium, iris/
ciliary body, and RPE.20 The explanation is consist-
ent with various clinical presentations of uveitis 
secondary to durvalumab treatment. Inflammation 
can be located in different eye regions - anterior, in-
termediate, posterior uveitis, as well as vasculitis, 
have now all been reported.6-8 
Uveitis commonly appears within the first six 
months of starting ICI immunotherapy.6 This inter-
val may be longer in durvalumab-associated uvei-
tis and vasculitis, as reported by Parikh et al. and 
Andrade et al. (13 and 20 months, respectively) as 
well as our cases (6 and 15 months).7,8When the first 
episode of uveitis is observed in a patient treated 
with an ICI, the basic workup should exclude com-
mon uveitic aetiologies.7 Overlooking infectious 
causes of uveitis can have harmful consequences 
for the patient, especially when treated with cor-
TABLE 2. Published cases reporting uveitis and optic disc oedema/papillitis secondary to other immune checkpoint inhibitors
Author, 
year
Immune 
checkpoint 
inhibitor
Target 
receptor
Cancer 
diagnosis
Clinical findings at 
presentation Complications Initial treatment
Discontinuing 
immune 
checkpoint 
inhibitor
Hahn et 
al., 20169 Ipilimumab CTLA-4
Malignant 
melanoma
AC inflammation, 
keratic precipitates
Panuveitis, papillitis, 
intraretinal, 
subfoveal fluid
Topical prednisolone acetate, 
brimonidine tartrate timolol maleate,
oral prednisolone 20 mg/day
Discontinued
Aaberg 
et al.,
201710
Pembrolizumab PD-1 Uveal melanoma
AC inflammation, 
vitreous cells and 
haze
Optic disc 
oedema, posterior 
uveitis, retinal 
vasculitis
Intraocular dexamethasone implant No.
Wang et 
al., 201911 Nivolumab PD-1 Renal carcinoma
AC inflammation, 
keratoprecipitates, 
posterior synechiae, 
vitreous floaters
Panuveitis, papillitis, 
serous retinal 
detachment
Intravenous methylprednisolone 
500 mg/day, followed by oral 
prednisolone 30 mg/day tapered 
over 2 months;
recurrence of uveitis managed with 
periocular methylprednisolone, and 
intraocular dexamethasone implant
Discontinued, 
resumed 6 
weeks after 
discontinuation, 
recurrence of 
uveitis 2 weeks 
after resumption
Reid et 
al., 201812 Pembrolizumab PD-1
Malignant 
melanoma
AC inflammation, 
vitreous cells, 
choroidal thickening, 
posterior synechiae
Panuveitis, optic 
disc oedema, 
hypotony
Oral prednisolone 75 mg/day 7 days, 
tapered over 3 weeks
Discontinued 
after 12 months 
commenced 
on nivolumab 
therapy
Navarro-
Perea et 
al., 201913
Pembrolizumab PD-1 Malignant melanoma
AC inflammation, 
irido-crystalline 
synechiae
Optic disc 
oedema
Topical dexamethasone, 
cyclopentolate, tropicamide, 
phenylephrine, oral prednisolone 40 
mg/day tapered over 2 months
Discontinued, 
replaced by 
vemurafenib 
and cobimetinib
Sun et al., 
20205 Nivolumab PD-1
Malignant 
melanoma
AC inflammation, 
vitreous cells, and 
haze
Optic disc 
oedema, ocular 
hypertension
Topical prednisolone acetate, oral 
prednisolone 60 mg/day n/a
Sun et al., 
20205 Pembrolizumab PD-1
Malignant 
melanoma AC inflammation Hypotony, Papillitis
Topical difluprednate, subtenon 
triamcinolone acetonide n/a
Sun et al., 
20205 Ipilimumab PD-1
Malignant 
melanoma
AC inflammation, 
vitreous cells
Macular oedema, 
Papillitis
Tiamcinolonetransseptal followed by 
retrobulbar) n/a
Kim et al.,
202014 Pembrolizumab PD-1 Renal carcinoma n/a Panuveitis, papillitis
Topical steroid,
posterior subtenon triamcinolone 
injection
Discontinued
Kim et al.,
202014 Pembrolizumab PD-1 Uveal melanoma n/a Panuveitis, papillitis Systemic steroid Discontinued
Kim et al.
202014 Pembrolizumab PD-1 Lung cancer n/a
Panuveitis, papillitis, 
uveal effusion Systemic steroid Discontinued
Kikuchi et 
al. 202015 Nivolumab PD-1
Hypopharyngeal 
cancer
Granulomatous 
mutton-fat keratic 
precipitates, AC 
inflammation, 
posterior synechiae
Panuveitis, papillitis, 
serous retinal 
detachment; Vogt-
Koyanagi-Harada 
disease-like uveitis
Sub-tenon triamcinolone acetonide, 
followed by methylprednisolone 
1000 mg/day 3 days, followed by 
oral methylprednisolone 50 mg/day 
tapered by 5 mg every week
Discontinued 
due to the 
patient’s 
deteriorating 
health
Vrabic 
et al. durvalumab PDL-1 NSCLC
AC inflammation, 
vitreous cells
Intermediate 
uveitis, optic dics 
oedema
Systemic steroid 500 mg/day 3 days, 
followed by oral methylprednisolone 
48 mg/day tapered over 6 weeks
Discontinued
AC = anterior chamber; CTLA-4 = cytotoxic T lymphocyte-associated protein 4; N/A not available; NSCVLC = non-small cell lung cancer; PD-1 = programmed cell death protein 1
Radiol Oncol 2022; 56(2): 129-137.
Vrabic N et al. / Uveitis associated with durvalumab 135
ticosteroids. Moreover, intravitreous metastasis 
should also be considered in the differential diag-
nosis, especially in patients with malignant mela-
noma.21
When bilateral optic disc oedema is present, the 
patient should undergo head imaging to exclude 
space-occupying lesions and intracranial progres-
sion of the malignancy. In addition, MRI should be 
performed when other neuro-ophthalmic compli-
cations related to ICI treatment, such as optic neu-
ritis, are suspected.22
After excluding common causes of uveitis and 
the distant spread of underlying malignancy, 
paraneoplastic aetiology remains an important 
consideration. In the first presented case, the con-
stellation of underlying ES-SCLC, subacute pain-
less bilateral visual loss, visual field loss, and bi-
lateral optic disc oedema might invoke differential 
diagnosis of paraneoplastic optic neuropathy.23-25 
However, visual loss in paraneoplastic optic neu-
ropathy tends to be severe and is usually insen-
sitive to methylprednisolone therapy.24 Though 
vitreous cells are often present, anterior uveitis 
is atypical.25 Moreover, MRI commonly shows 
abnormalities in the course of the optic nerves24, 
and other neurological deficits usually accompany 
the disease25, which were not present in this case. 
When paraneoplastic optic neuropathy is likely, 
lumbar puncture and paraneoplastic autoanti-
body screening may be helpful.23,25 
In the second case, cancer-associated retinopa-
thy (CAR) might be considered in the differential 
diagnosis. Although uncommon, CAR has been re-
ported to occur with NSCLC.26,27 Some authors base 
their diagnosis of CAR on distinctive ophthalmo-
logical manifestations28, although the presence of 
circulating autoantibodies against retinal antigens 
is required to confirm this diagnosis.29 Several find-
ings in our case were compatible with CAR: acute 
visual acuity deterioration, anterior and posterior 
segment inflammation, and pathological changes 
in the outer retinal layers. Other findings charac-
teristic of CAR such as photopsia, night blindness, 
outer retinal atrophy with foveolar sparing, vessel 
FIGURE 5. Case II. (A) Fundoscopy, prior to non-small cell lung cancer 
diagnosis in 2013: posterior pole and peripheral retinal changes. (B) Colour 
fundus photography at presentation in March 2021: multiple flat, grey-
white lesions (black arrows) are visible at presentation. (C) Three weeks 
on methylprednisolone treatment in April 2021: a diminishment of lesions 
(white arrows) is observed.
OD = oculus dexter; OS(L) = oculus sinister
FIGURE 6. Case II. (A) Macular optical coherence tomography 
(OCT) presentation and (B) two weeks on methylprednisolone 
treatment. Loss of ellipsoid zone and hyperreflective haze 
in outer plexiform and outer nuclear layers is evident at 
presentation. Indocyanine angiography at presentation 
shows hypofluorescent lesions corresponding to ellipsoid zone 
disruptions (white arrows). Two weeks on methylprednisolone 
treatment ellipsoid zone appears granular.
OD = oculus dexter; OS(L) = oculus sinister
A
B
C
A
B
Radiol Oncol 2022; 56(2): 129-137.
Vrabic N et al. / Uveitis associated with durvalumab136
attenuation, and arteriolar narrowing on fundos-
copy were absent in our case.28-30 Although retinal 
autoantibody testing, visual field, and electroreti-
nogram testing were not performed, the diagnosis 
of CAR was thought to be unlikely in our case. 
There is no standardised approach to treating 
the ocular inflammatory adverse effects occurring 
with the ICI treatment. Uveitic complications sec-
ondary to ICIs are commonly treated with a local 
and/or systemic corticosteroid.5,6-15 There is little 
experience in treating uveitic complications of ICI 
with other immunomodulatory therapy. 
Some uveitic cases resolve with discontinuation 
of ICI therapy7,13; in others, the inflammation may 
persist after ICI discontinuation.18 In our first case, 
the patient was discontinued from durvalumab 
treatment not only due to grade 3 ocular toxicity 
according to Common terminology criteria for ad-
verse events (CTCAE) and disease progression but 
also due to the progression of the underlying ES-
SCLC. In the second case, the patient completed 
durvalumab therapy, and remission of NSCLC was 
achieved prior to presenting with bilateral poste-
rior uveitis. Both patients were treated with a sys-
temic corticosteroid. Slight amelioration of BCVA 
and diminution of inflammation were achieved 
in both cases. Moreover, we observed decreased 
swelling of the optic discs in the first case. Visual 
field defects largely persisted and were likely the 
consequence of the underlying bilateral optic disc 
drusen.31 Bilateral atrophy of the retinal nerve fiber 
layer (RNFL) and ganglion cell layer (GCL) noted 
at presentation in the first case were believed con-
sequent to optic disc drusen (Supplementary File 1. 
Supplementary Figure 1).32 Since no alteration of the 
optic disc drusen was observed on corticosteroid 
treatment (Figure 2), progression of RNFL and GCL 
FIGURE 7. Case II. Fluorescein angiography at presentation, early and late 
frames. Note surface capillary net dilatation and late staining of the papilla 
and hypofluorescent areas on the posterior pole and periphery. Indocyanine 
angiography at presentation showing hypofluorescent lesions.
OD = oculus dexter; OS(L) = oculus sinister
FIGURE 8. Case II. Fundus autofluorescence images at pres-
entation show no pathologic changes. Hyperautofluorescent 
spots are visible three weeks on methylprednisolone treatment.
AF = fundus autofluorescence; OD = oculus dexter; OS(L) = oculus sinister
Radiol Oncol 2022; 56(2): 129-137.
Vrabic N et al. / Uveitis associated with durvalumab 137
atrophy (Supplementary File 1. Supplementary 
Figure 1) was considered consequent to the optic 
disc oedema. In this patient, hyperreflective spots 
in the inner nuclear and outer plexiform layers on 
the macular OCT scan possibly corresponded to 
activated microglia.33Inflammatory eye conditions 
secondary to immune checkpoint inhibitors re-
quire a thorough diagnostic workup. Once the di-
agnosis is established, treatment, commonly with a 
local or systemic corticosteroid, should be adapted 
to the severity of the inflammation. CTCAE is a 
helpful tool in deciding upon discontinuing the 
immunomodulatory treatment.
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