Title: Irvine-Gass Syndrome Serendipitous Resolution Following Systemic Pembrolizumab for Lung Adenocarcinoma: A Case Report

Authors: Roque De Monte Furtado¹, Mr Abdulmalik Alsaif², Mr Dominic McHugh²

Affiliations: ¹GKT School of Medical Education, King's College London, London, UK; ²Department of Ophthalmology, King's College Hospital NHS Foundation Trust, London, UK

 

Introduction

• Irvine-Gass syndrome is a common post-cataract complication (1–2% clinically significant).

• Pathophysiology: Multifactorial inflammatory origin; surgical trauma releases mediators like VEGF, impairing the blood-retinal barrier.

• Management: Typically topical NSAIDs/steroids; refractory cases use anti-VEGF or intravitreal steroids.

   

Case Details

• 75-year-old male, 12 weeks post-uncomplicated cataract surgery (LE).

• Visual deterioration (VA 6/24-1).

• Significant CMO with Central Macular Thickness (CMT) of 717µm.

• No ophthalmic treatment was initiated due to a concurrent diagnosis of primary lung adenocarcinoma.

   

Oncological Treatment For Lung Cancer

• Patient started systemic chemotherapy: Pembrolizumab, Pemetrexed, and Carboplatin. 

• Received 3 cycles over 3 months.

• Pembrolizumab is an immune checkpoint inhibitor (ICI) which uses monoclonal antibodies to target the programmed cell death protein 1 (PD-1).

Results

• One day following the third cycle of Pembrolizumab-containing chemotherapy, the patient returned for ophthalmic review.

• Key Finding: Complete resolution of CMO without any topical or intravitreal ocular therapy.

• Quantitative Change: Baseline CMT: 717µm; Post-Pembrolizumab CMT: 289µm. Reduction: 428µm (approx. 60%).

   

Proposed Mechanisms

• Mechanism 1: Immune Modulation: Through the regulation of the immune microenvironment, pembrolizumab may have contributed to the reduction of intraocular inflammation.

• Mechanism 2: Vascular Normalisation: ICIs are known to reduce vascular permeability and restore the blood-retinal barrier. 

Conclusion

• This case provides clinical evidence that ICIs can restore the blood-retinal barrier in Irvine-Gass Syndrome.

• Further study into these immunotherapies may provide new avenues for treating refractory retinal vascular conditions.

   

References

1. Henderson BA, et al. J Cataract Refract Surg. 2007 Sep;33(9):1550-8.

2. Melo V, et al. Front Cell Dev Biol. 2022 May 30;10:908389.

3. Wakabayashi Y, et al. Acta Ophthalmol. 2022 May;100(3):e860-e861.