{
  "abstract": "Immunotherapy has revolutionized cancer treatment but has also been associated with various immune-related adverse events. Triple M syndrome is a particularly rare and life-threatening adverse effect, which encompasses the overlap of immune checkpoint inhibitor-induced myasthenia gravis, myositis, and myocarditis. In this case series, we highlight the ocular manifestations of Triple M Syndrome, which, when recognized in conjunction with other systemic symptoms, can crucially lead to early diagnosis and intervention that may help to improve patient outcomes. Patient 1, a 69 year-old woman, presented with a 1-week history of bilateral ptosis and near complete ophthalmoplegia in both eyes 2 weeks after her second dose of combination therapy of Nivolumab and Ipilimumab for renal cell carcinoma. Patient 2, an 81 year old female, presented with a 3-day history of diplopia, right-sided ptosis, and bilateral partial ophthalmoplegia 2 weeks after completing her second dose of Nivolumab for cecal adenocarcinoma. Patient 3, a 69 year-old male, presented with a 2-week history of bilateral ptosis and poor peripheral vision 4 weeks following his first dose of Durvalumab for squamous cell lung carcinoma. All 3 patients progressed to Triple M Syndrome. Ophthalmologists may play an important role in identifying Triple M Syndrome, a rare but increasingly noted side effect of immune-checkpoint inhibitors. This case series highlights presenting symptoms that should prompt early recognition of Triple M Syndrome and also emphasizes the need for urgent referral to a multi-disciplinary care center for appropriate workup and inpatient management.",
  "abstract_shown": true,
  "affiliations": [
    "Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.",
    "Department of Ophthalmology, The MetroHealth System, Cleveland, OH, USA.",
    "Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA.",
    "Uveitis Center of Excellence, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.",
    "Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, OH, USA."
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 4,
  "authors": [
    {
      "affs": [
        0,
        1
      ],
      "name": "John Moir"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Meghana Chalasani"
    },
    {
      "affs": [
        0,
        1,
        2,
        3
      ],
      "name": "Sunil K Srivastava"
    },
    {
      "affs": [
        0,
        2,
        4
      ],
      "name": "Amy S Babiuch"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/fsyw7pr10kfb8.bib",
  "cited_by": 0,
  "doi": "10.1016/j.ajoc.2026.102699",
  "fulltext_url": "https://europepmc.org/articles/PMC13742127",
  "id": "fsyw7pr10kfb8",
  "issns": [
    "2451-9936"
  ],
  "landing_url": "https://europepmc.org/article/MED/42997656",
  "language": "eng",
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2730|Cancer Immunotherapy and Biomarkers"
    ]
  ],
  "openalex": "W7223702654",
  "pdf_url": "https://europepmc.org/articles/PMC13742127?pdf=render",
  "pmcid": "PMC13742127",
  "pmid": "42997656",
  "published": "2026-10-26",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/fsyw7pr10kfb8.ris",
  "sources": [
    {
      "first_seen": "2026-11-09T15:20:34Z",
      "native_id": "MED:42997656",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42997656"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2730|Cancer Immunotherapy and Biomarkers",
      "subfield": "oncology"
    }
  ],
  "title": "Immune checkpoint inhibitor induced Triple-M syndrome: A case series detailing what every ophthalmologist should know.",
  "title_text": "Immune checkpoint inhibitor induced Triple-M syndrome: A case series detailing what every ophthalmologist should know.",
  "type": "peer-reviewed",
  "updated_at": "2026-11-09T15:20:34Z",
  "url": "https://research.draconitic.com/paper/fsyw7pr10kfb8",
  "venue": "American journal of ophthalmology case reports",
  "versions": []
}