Author’s Disclosure Block: Jack Mouhanna, none; Sheetal Pundir, none; Jesia Hasan, none

Abstract Body
Purpose:Immune checkpoint inhibitors and targeted therapies are the mainstay treatment for advanced melanoma. The combination of a BRAF kinase inhibitor (BRAFi) and a MEK kinase inhibitor (MEKi) is particularly effective in patients with melanoma harboring the common BRAF V600R mutation. Ocular immune-related adverse events associated with immune checkpoint inhibitors are increasingly reported, with anterior uveitis being the most common. This is a unique case demonstrating differing patterns of uveitis within the same patient ranging from Vogt-Koyanagi-Harada (VKH)-like syndrome on immune checkpoint inhibitors to non-granulomatous acute anterior uveitis on BRAFi/MEKi targeted therapy. Study Design: Case report and review of the literature. Methods: We present a rare case demonstrating several systemic and ocular adverse events while on different treatment regimens for metastatic melanoma. Fundus and external photographs as well as B-scan ultrasonography and ocular coherence tomography images at different timepoints are presented. Results: A 59-year-old male with BRAF V600R-mutated gastrointestinal melanoma metastatic to the lung presented with VKH-like bilateral uveitis that was more prominent in the right eye while being treated with the immune checkpoint inhibitor nivolumab. The clinical findings included poliosis, vitiligo, anterior chamber and vitreous cells, intraretinal and subretinal fluid, and choroidal folds. Inflammation resolved with topical and oral steroids and discontinuation of nivolumab by oncology. Subsequently, the patient developed bilateral non-granulomatous acute anterior uveitis that was more prominent in the left eye with seclusio pupillae while being treated with BRAFi/MEKi targeted therapy using the combination of encorafenib and binimetinib. Inflammation slowly improved on topical steroids and resolved following subtenon triamcinolone in the left eye. Additional systemic adverse events included hepatitis and infusion reaction with immune checkpoint inhibition and recurrent pyrexia syndrome, myalgias, headaches and general malaise with BRAFi/MEKi targeted therapy. Conclusions: Differing patternsof ocular inflammation associated with immune checkpoint inhibition and targeted therapies reflect the intricacies of the little-known underlying mechanisms. This emphasizes the value of ophthalmological evaluation and interdisciplinary collaboration in the diagnosis and management of various ocular immune-related adverse events.