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Jose Garcia-Arumi, Daniel Velazquez Villoria, Miguel A Zapata; Effects of oncologic MEK-inhibitor therapy in retina and choroid. Invest. Ophthalmol. Vis. Sci. 2016;57(12):1117.
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© 2017 Association for Research in Vision and Ophthalmology.
Controversy exists regarding the clinical characteristics and outcome of a serous retinopathy associated with mitogen-activated protein kinase (MEK) inhibitor therapy used in oncologic patients with cutaneous melanoma. Our purpose is to describe the chorio-retinal findings in oncologic patients under MEK-inhibitor therapy.
Retrospective review of 68 patients under MEK inhibitor therapy for oncological diseases. Extensive ophthalmic examination was performed, including visual acuity, visual field testing, slit-lamp examination, indirect ophthalmoscopy, digital color fundus photography, and optical coherence tomography (OCT). In selected cases, additional examinations were performed, including fluorescein angiography. Main outcome measures were visual symptoms, visual acuity, and analysis of OCT findings in retina and choroid.
68 patients under MEK inhibitor therapy were included. Ten patients (14,7%) reported visual symptoms during the study. The mean time to the onset of symptoms, which were mild and transient, was 1,5 days (range, <1hour to 3 days). Chorio-retinal abnormalities in OCT imaging were found in 26 out of 68 (38,2%) patients. The most common OCT finding was a mild separation between the third and the fourth hyperreflective bands of the outer retina. On OCT, neurosensory detachment (NSD) was detected in 23 (33,8%) of patients. In the 23 patients with NSD, the fovea was affected in 17 patients (73,9%). Multifocal and more severe NSD were associated to higher drug doses (r=0,428, P=0,02). Stopping and reintroduction of the drug at a lower dose did not seem to cause new NSD. Complete disappearance of OCT abnormalities was recorded in 21 out of 26 (80,7%) of patients.
A time-dependent and reversible serous retinopathy can develop in patients under MEK inhibitor therapy. A minority of patients develop visual symptoms, which are generally mild and transient. An asymptomatic separation between the third and fourth hyperreflective band is the most common OCT finding in patients under MEK inhibitor therapy. More severe and multifocal neurosensory detachments could be related to higher doses.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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