How do you manage checkpoint inhibitor-associated Vogt-Koyanagi-Harada (VKH) disease in patients who have poorly controlled diabetes?

Management of ocular inflammation secondary to immune checkpoint inhibitors (ICPIs) is a balance between managing ocular disease and not negatively impacting treatment of the underlying malignancy. If there is ICPI-associated VKH disease with serous retinal detachment, use of corticosteroids is unavoidable. After a discussion with the treating oncologist, I will initiate high-dose oral steroids (1 mg/kg/day) with a gradual taper. For some patients, I may start with 3 days of 1 g of IV Solumedrol. If a patient is a poorly controlled diabetic and they need IV solumedrol, I will have them admitted to both receive the IV steroids and adjust their diabetes medications to allow for safe use of systemic glucocorticoids. Regardless, I coordinate wi...