Ben-Avi Ravid, Dori Dalia, Chowers Itay
Department of Ophthalmology, Hadassah Medical Center, Kiryat Hadassah, POB 12000, Jerusalem, 91120, Israel.
Department of Ophthalmology, Rambam Health Care Campus, Affiliated to the Technion - Israel Institute of Technology, Haifa, Israel.
Am J Ophthalmol Case Rep. 2022 Feb 18;26:101436. doi: 10.1016/j.ajoc.2022.101436. eCollection 2022 Jun.
To describe a unique case of cystoid macular edema associated with Ibrutinib treatment for Chronic Lymphocytic Leukemia (CLL).
A 73-year-old male patient presented to the ophthalmology clinic complaining of decreased vision in his seeing-eye ('only eye', left). Further clinal examination and imaging revealed the presence of a cystoid macular edema (CME). With no apparent cause to this condition, topical treatment with NSAIDS and steroids continued over two years with only partial response and persistent macular edema, resulting in decreased vision. Cessation of Ibrutinib treatment resulted in resolution of the macular edema and improvement in visual acuity over 6 months.
Several novel oncologic therapies have been associated with CME in recent years. This case demonstrates an association between Ibrutinib an oral, irreversible inhibitor of Bruton's Tyrosine Kinase (BTK), and the development of CME. CME was resistant to topical treatment but resolved after treatment cessation. Along with two previous cases reported, this case suggests that CME is a rare adverse event of Ibrutinib therapy. Screening for CME in Ibrutinib treated patients who report visual symptoms should be considered.
描述一例与依鲁替尼治疗慢性淋巴细胞白血病（CLL）相关的黄斑囊样水肿的独特病例。
一名73岁男性患者前往眼科诊所，主诉其导盲眼（“仅有的眼睛”，左眼）视力下降。进一步的临床检查和影像学检查显示存在黄斑囊样水肿（CME）。由于该病症无明显病因，使用非甾体抗炎药和类固醇进行局部治疗持续了两年，仅部分有效且黄斑水肿持续存在，导致视力下降。停用依鲁替尼治疗后，黄斑水肿在6个月内消退，视力改善。
近年来，几种新型肿瘤治疗方法与CME有关。本病例证明了依鲁替尼（一种口服的、不可逆的布鲁顿酪氨酸激酶（BTK）抑制剂）与CME的发生之间存在关联。CME对局部治疗有抵抗性，但在停止治疗后消退。连同之前报道的两例病例，本病例表明CME是依鲁替尼治疗罕见的不良事件。对于报告有视觉症状的接受依鲁替尼治疗的患者，应考虑筛查CME。
