Abstract
Purpose :
To determine if systemic tyrosine kinase inhibitor (TKI) use leads to the development of a retinal vein occlusion (RVO).
Methods :
A retrospective electronic medical record (EMR) search was done to find all patients at a single institution taking a systemic TKI and having a diagnosis of RVO. Charts were then reviewed to determine the correlation of RVO to TKI use. Risk factors reviewed included age, hypertension (HTN), hyperlipidemia (HLD), smoking status and hemoglobin A1c (HgbA1c) prior to diagnosis of a RVO.
Results :
Ten eyes of nine patients with a mean age of 76 years (range 59-93 years) were identified (two women and seven men). Eight of nine patients had pre-existing HTN, three of nine patients had pre-existing diabetes mellitus (DM) on treatment and one of nine patients was being treated for HLD. Four patients were former smokers and five patients were never smokers. The reason for taking a TKI in three patients was chronic myeloid leukemia, two with chronic lymphocytic leukemia, three with renal cell carcinoma, and one with a gastrointestinal stromal tumor (GIST). Five patients were taking ibrutinib, three patients were taking axitinib, and one patient was taking regorafenib. An average of 3.4 years (range 1 year – 6.5 years) between initiation of TKI and RVO presentation was noted. Seven of nine patients presented with a non-ischemic RVO, while two patients presented with an ischemic RVO. Presenting vision ranged from 20/30 to CF, while most recent vision ranged from 20/25 to CF. Eight of nine patients required intravitreal anti-VEGF injections, with one of nine patients requiring an intraocular steroid injection. One patient discontinued the TKI due to RVO; two patients discontinued the TKI due to worsening disease, and six patients have continued the TKIs despite having a RVO. Using the Naranjo scale, the average score was 4 points (range 4 – 5 points).
Conclusions :
This is the first case series to document a potential correlation with RVO with systemic use of TKIs. While cancer is a risk factor for an RVO, we have noticed a trend between patients who take systemic TKIs and the subsequent development of an RVO. Patients taking systemic TKIs should be seen with a retinal specialist if they develop symptoms of blurred vision. Given the patients had other with independent risk factors, it is not established what role TKIs have in the development of an RVO. Further study is needed.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.