New features in MEK retinopathy.
New features in MEK retinopathy.
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DOI：
10.1186/s12886-018-0861-8
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发表时间：
2018-09-14
影响因子：
2
通讯作者：
Santiago C
中科院分区：
文献类型：
--
作者：
Tyagi P;Santiago C
分子靶向治疗在肿瘤学中的应用正变得越来越广泛。这些药物在信号转导途径中引起肿瘤特异性基因改变，因此不那么普遍的毒性。达普拉非尼是一种BRAF抑制剂，曲美替尼是一种MEK抑制剂，是最近被批准用于治疗晚期、无法切除的黑色素瘤的两种分子靶向药物。MEK视网膜病变是最近引入的一个术语，用于描述继发于MEK抑制剂的视网膜毒性。一名71岁的男子在两周内的中央视力中出现了“圆形的绿色斑块”。他患有多次复发的IV期BRAF基因突变型恶性黑色素瘤。他分别接受了达普拉非尼(Tafinlar)7个月和曲美替尼(Mekinist)4个月的治疗。眼底看起来很正常。OCT扫描可见双侧对称性黄斑囊样水肿，视网膜内及视网膜下积液，椭圆形带增厚，视网膜下颗粒沉积。症状随着暂时停止化疗而缓解，但OCT征象仍然存在。此病例报告确认了MEK视网膜病变的两个新的显著特征：椭圆区增厚和视网膜下颗粒沉积的星空分布模式。这些变化意味着光感受器/RPE毒性和功能障碍。视网膜下颗粒沉积显示自发荧光增强，提示RPE功能障碍导致脂褐素清除异常。分子靶向治疗给肿瘤治疗带来了革命性的变化，提高了患者的生存率。这些药物相对较新，最近被批准用于临床，其中大多数与眼部毒性有关。了解眼部症状、药物的副作用概况、监测机制以及肿瘤学家和眼科护理人员与眼科影像的联系是早期诊断和处理眼部不良事件的关键。
The use of molecularly targeted therapy is becoming widespread in oncology. These agents cause tumour-specific genetic alterations in signal transduction pathways, hence less generalised toxicity. Dabrafenib, a BRAF inhibitor and Trametinib, a MEK inhibitor are two molecularly targeted agents recently approved for treatment of advanced, unresectable melanomas. MEK retinopathy is a recently introduced term describing retinal toxicity secondary to MEK inhibitors. A 71-year-old man presented with ‘circular, green patches’ in his central vision for 2 weeks. He had multiple relapsed stage IV BRAF gene mutant malignant melanoma. He was on treatment with Dabrafenib (Tafinlar) for 7 months and Trametinib (Mekinist) for 4 months respectively. The fundus looked normal. The OCT scan showed bilateral symmetrical cystoid macular edema, intraretinal and subretinal fluid, thickening of elliposoid zone and subretinal granular deposits. The symptoms resolved with temporary cessation of chemotherapy but OCT signs persisted. This case report identifies two new remarkable features of MEK retinopathy as thickening of ellipsoid zone and ‘starry sky’ pattern of distribution of subretinal granular deposits. These changes signify photoreceptors/ RPE toxicity and dysfunction. The subretinal granular deposits showed increased autofluorescence suggested abnormal lipofuscin clearance due to RPE dysfunction. The molecularly targeted therapy has revolutionized the cancer treatment and increased the survival rate. These agents are relatively new and recently approved for clinical use and most of them are associated with ocular toxicities. Awareness of ocular symptoms, side-effect profile of drugs, monitoring regime and liaison between oncologist and eye care professional with ocular imaging is key to early diagnosis and management of ocular adverse events.
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影响因子：
4.2
作者：
Niro, Alfredo;Strippoli, Sabino;Guida, Michele
通讯作者：
Guida, Michele
影响因子：
1.9
作者：
Kuznetsova AV;Kurinov AM;Aleksandrova MA
通讯作者：
Aleksandrova MA
影响因子：
2.3
作者：
Huang, Wenhu;Yang, Amy H.;Younis, Husam S.
通讯作者：
Younis, Husam S.
影响因子：
50.5
作者：
Urner-Bloch, U.;Urner, M.;Goldinger, S. M.
通讯作者：
Goldinger, S. M.
DOI：
10.1155/2013/673796
发表时间：
2013
期刊：
Case reports in ophthalmological medicine
影响因子：
--
作者：
Schoenberger SD;Kim SJ
通讯作者：
Kim SJ