We read with interest the review “Paraneoplastic ocular syndrome: a pandora’s box of underlying malignancies” by Sarkar et al. [1], proving an overview of paraneoplastic ocular syndromes, including melanoma-associated retinopathy (MAR) [1]. It was highlighted that, although systemic immunotherapy is considered the first-line treatment for MAR, the use of immune checkpoint inhibitors can lead to immune-related adverse events, including MAR [1, 2]. We describe two cases of MAR presented after starting systemic immunotherapy.

Case 1, a 60-year woman, presented with bilateral cloudy vision during maintenance monthly nivolumab monotherapy, started after 4 cycles of ipilimumab/nivolumab, 6 months earlier. Her best-corrected visual acuity (BCVA) was 6/9 and 6/7.5 in the right and left eye, respectively, and ophthalmic examination showed bilateral anterior and intermediate uveitis. Fluorescein angiography showed minimal vasculitis and visual field (VF) test a bilateral generalized constriction, worse in the left eye.

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