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Anne L Kunkler, Elaine Michele Binkley, Dimosthenis Mantopoulos, Kari Kendra, Colleen M Cebulla; Ocular side effects of traditional chemotherapeutics and small molecule inhibitors. Invest. Ophthalmol. Vis. Sci. 2016;57(12):299.
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© ARVO (1962-2015); The Authors (2016-present)
Traditional chemotherapeutics and small molecule inhibitors have dramatically changed the prognosis for patients suffering from a variety of malignancies. However, limited data are available regarding the ocular side effects of many of these novel agents. This retrospective, observational study aims to examine the ocular side effects of traditional chemotherapeutics and small molecule inhibitors in patients treated for their malignancy at the Ohio State University.
Approval was obtained from the institutional review board at the Ohio State University. A search of the electronic medical record was performed for patients treated with chemotherapeutic agents who were seen in the department of ophthalmology between 1/1/2010 and 2/2/2015. This search yielded 3,253 cases and for the current project we analyzed the first 1,000 cases. Patients known to the investigators were also included. We identified seven patients who experienced ocular side effects while being treated with traditional agents and small molecule inhibitors including ibrutinib, dabrafenib/trametinib, MEK 162, crizotinib, and FOLFOX (folinic acid, fluorouracil, oxaliplatin).
Small molecule inhibitors were associated with dry eye, palinopsia, photophobia, branch retinal artery occlusion, and posterior vitreous detachment. Ibrutinib and crizotinib were the most frequent medications used in this category. The most common presenting symptom was mild to moderate vision loss (4/6 or 67%). The majority of patients remained on treatment (5/6 or 83%) and for three of the patients the symptoms resolved completely (3/6 or 50%). The most serious adverse drug event was a branch retinal artery occlusion in a patient receiving ibrutinib, which resulted in permanent vision loss. One patient treated with the traditional regimen FOLFOX developed optic disc hyperemia, which resolved after discontinuing treatment.
This study identified a number of ocular side effects in patients treated with both traditional chemotherapeutics and small molecule inhibitors. The side effects varied from mild to severe, including irreversible vision loss secondary to retinal vascular occlusion. We hope that this study will aid in the development of improved screening and treatment protocols for patients receiving these medications.
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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