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A 52-year-old man with metastatic superficial spreading melanoma developed bilateral ocular redness and photopsias after two years of pembrolizumab. Visual acuity remained preserved. Multifocal pigmentary fundus changes, corresponding hypoautofluorescence on FAF, and multifocal hypercyanescent lesions on ICGA indicated choriocapillaritis. Orbital MRI showed extraocular muscle enlargement and intraconal fat inflammation consistent with posterior orbitopathy, without exophthalmos or optic nerve compression. With excellent systemic response and preserved vision, pembrolizumab was continued with topical corticosteroids and close follow-up; systemic steroids were reserved for progression.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/pembrolizumab-induced-choriocapillaritis-and-orbital-inflammation-a-case-report/458500/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/pembrolizumab-induced-choriocapillaritis-and-orbital-inflammation-a-case-report/458500.png","ImageObject",300,407,{"name":92,"@type":93},"Đào","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":29},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What treatment is associated with this ocular condition in the case report?","Question",{"text":112,"@type":113},"The report links the condition to pembrolizumab, an immune checkpoint inhibitor.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What ocular findings supported the diagnosis of choriocapillaritis?",{"text":117,"@type":113},"Fundus examination showed multifocal pigmentary changes; fundus autofluorescence demonstrated corresponding hypoautofluorescent spots, and indocyanine green angiography revealed multifocal hypercyanescent lesions consistent with choriocapillaritis.",{"name":119,"@type":110,"acceptedAnswer":120},"How was pembrolizumab managed after ocular involvement was identified?",{"text":121,"@type":113},"Because systemic response was excellent and vision was preserved, the multidisciplinary team elected to continue pembrolizumab, start topical corticosteroids, and arrange close ophthalmologic follow-up; systemic corticosteroids were reserved for possible progression.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},458500,1791115564,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":29,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":139,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":145,"preview_page_count":4},1374402968488,"https://ap-avatar.wpscdn.com/davatar_29158cc5080c5b710cf443261637dec0","Review began 11/29/2025  \nReview ended 12/03/2025  \nPublished 12/08/2025  \n© Copyright 2025  \nEl Korno et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CCBY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited.  \nDOI: 10.7759/cureus.98725  \nOpen Access Case Report  \nPembrolizumab-Induced Choriocapillaritis and Orbital Inflammation: A Case Report  \nOumaima El Korno 1 , Zineb Hilali 1, Taha Boutaj 1 , Hassna El Ghazi 1 , Saad Benchekroun 1, Samira Tachfouti 1, Abdellah Amazouzi 1, Lalla Ouafa Cherkaoui 1, 2  \n1. Ophthalmology, Centre Hospitalo-Universitaire Ibn Sina, Hôpital des Specialités, Rabat, MAR 2. Ophthalmology, Mohammed V University, Hôpital des Specialités, Rabat, MAR  \nCorresponding author: Oumaima El Korno, [elkornooumaima98@gmail.com](elkornooumaima98@gmail.com)  \nAbstract  \nImmune checkpoint inhibitors (ICIs) such as pembrolizumab have significantly extended patient survival in metastatic melanoma; however, they may rarely induce heterogeneous and potentially vision-threatening ocular immune-related adverse events (irAEs) . We report a case of a 52-year-old man with metastatic superficial spreading melanoma who, after two years of pembrolizumab therapy, presented with bilateral ocular redness and photopsias. Visual acuity was preserved in both eyes. Fundus examination showed multifocal pigmentary changes. Fundus autofluorescence (FAF) revealed corresponding hypoautofluorescent spots without macular involvement, and indocyanine green angiography (ICGA) demonstrated multifocal hypercyanescent lesions consistent with choriocapillaritis. Orbital MRI demonstrated extraocular muscle enlargement and intraconal fat inflammation suggestive of posterior orbitopathy, without exophthalmos or optic nerve compression. Given the excellent systemic response and preserved vision, a multidisciplinary team elected to continue pembrolizumab, initiate topical corticosteroids, and ensure close ophthalmologic follow-up. Systemic corticosteroids were reserved for potential progression.  \nThis rare association of multifocal choriocapillaritis and posterior orbitopathy under pembrolizumab underscores the expanding spectrum of ocular irAEs. Importantly, when findings are mild and vision is preserved, pembrolizumab may be continued with local treatment. Early recognition and close collaboration between ophthalmology and oncology are essential to prevent irreversible visual morbidity while maintaining optimal oncologic outcomes.  \nCategories: Therapeutics, Ophthalmology, Oncology  \nKeywords: autoimmune choriocapillaritis, immune checkpoint inhibitors, immune-mediated ocular inflammation, medical oncology, melanoma, ocular immune-related adverse events, orbital inflammatory disease, pembrolizumab  \nIntroduction  \nImmune checkpoint inhibitors (ICIs) such as anti-programmed cell death 1 (anti-PD-1; pembrolizumab, nivolumab), anti-programmed cell death-ligand 1 (anti-PD-L1), and anti-cytotoxic T-lymphocyte-associated protein-4 (anti-CTLA-4) agents have reshaped the management of advanced melanoma by restoring antitumor immune activity. Since their first approval in 2011, their indications have progressively expanded to multiple malignancies, including non-small cell lung cancer, urothelial carcinoma, cutaneous  \nmalignancies, and lymphomas [1,2] .  \nBy enhancing T-cell activation, ICIs can induce immune-related adverse events (irAEs) affecting multiple organs. Ocular irAEs are uncommon but may be vision-threatening, with reported manifestations ranging from ocular surface disease and uveitis to orbital inflammation and posterior segment involvement such as serous retinal detachment, birdshot-like chorioretinopathy, and optic neuritis [3-5]. Because most published data consist of isolated reports, each additional case contributes to improved recognition and management of these reactions.  \nWe present a","cbCaiazlqofjM4SU","https://ap.wps.com/l/cbCaiazlqofjM4SU","pdf",7871230,11,"English","# Abstract\n## Introduction\n## Case Presentation\n## How to cite this article","[{\"question\":\"What treatment is associated with this ocular condition in the case report?\",\"answer\":\"The report links the condition to pembrolizumab, an immune checkpoint inhibitor.\"},{\"question\":\"What ocular findings supported the diagnosis of choriocapillaritis?\",\"answer\":\"Fundus examination showed multifocal pigmentary changes; fundus autofluorescence demonstrated corresponding hypoautofluorescent spots, and indocyanine green angiography revealed multifocal hypercyanescent lesions consistent with choriocapillaritis.\"},{\"question\":\"How was pembrolizumab managed after ocular involvement was identified?\",\"answer\":\"Because systemic response was excellent and vision was preserved, the multidisciplinary team elected to continue pembrolizumab, start topical corticosteroids, and arrange close ophthalmologic follow-up; systemic corticosteroids were reserved for possible progression.\"}]","Pembrolizumab-Induced Choriocapillaritis and Orbital Inflammation - A Case Report | PDF",1790753433,28]