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Frederick W Fraunfelder, Frederick T Fraunfelder; Oral Anti–Vascular Endothelial Growth Factor (VEGF) Drugs and Ocular Side Effects. Invest. Ophthalmol. Vis. Sci. 2018;59(9):4313.
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Purpose: To evaluate possible associations between oral anti–vascular endothelial growth factor (VEGF) drugs and ocular side effects.
Methods: Spontaneous reports from the World Health Organization (WHO), Food and Drug Administration (FDA), Japanese Pharmaceuticals and Medical Devices Agency (PMDA), and European Medicines Agency (EMA) were collected and evaluated by the National Registry of Drug-Induced Ocular Side Effects (DIOSE) on the three oral anti-VEGF drugs (pazopanib, sorafenib, and sunitinib) and possible ocular side effects when given for cancer chemotherapy.
Results: Reported side effects include blurred or decreased vision (389 cases); periocular or eyelid edema (273 cases); superficial anterior segment toxicity (270 cases); conjunctival, retinal, or vitreous bleeding (77 cases); retinal detachments (RD) or retinal tears (RT) (75 cases); extraocular muscle disorders, including ptosis (51 cases); discoloration of eyelashes (36 cases); retinal arterial or venous occlusions (26 cases); optic nerve disorders, including papilledema and ischemic optic neuropathy (21 cases); uveitis (10 cases), and macular edema (7 cases). Spontaneous reports of possible RD or RT have been associated with pazopanib (31 RD, 12 RT), sunitinib (24 RD, 0 RT), and sorafenib (7 RD, 2 RT).
Conclusion: Potent oral anti-VEGF drugs used in cancer chemotherapy may cause ocular side effects. Most are superficial anterior segment effects and may be secondary to direct exposure to the drug or its metabolites, which may be secreted in the tears. Most are transitory and reversible. Pazopanib has been reported to possibly be linked to RDs and RTs. This study suggests that sorafenib and sunitinib are suspected as well. Serous retinal detachments (SRD) may possibly occur and may absorb if the drug is discontinued. The association of oral anti-VEGF drugs with SRD, while rare, is plausible. Due to the seriousness of RD or RT, patients who are started on this class of drugs should be instructed to seek immediate ophthalmic consultation if symptoms occur.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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