Carlà Matteo Mario, Mateo Carlos
Ophthalmology Department, "Fondazione Policlinico Universitario A. Gemelli, IRCCS", 00168, Rome, Italy.
Ophthalmology Department, Catholic University "Sacro Cuore", Rome, Italy.
Am J Ophthalmol Case Rep. 2024 Oct 18;36:102200. doi: 10.1016/j.ajoc.2024.102200. eCollection 2024 Dec.
We report a case of retinal toxicity induced by SBP-101, a polyamine inhibitor for the treatment of metastatic pancreatic adenocarcinoma, presenting as rapidly progressive bilateral central retinal pigmented epithelium (RPE) atrophy in a patient with a silent ocular history.
A 69-year-old female patient with a metastatic pancreatic adenocarcinoma visited our retina clinic referring a 6-months history of blurred vision and progressive visual field loss. One year before, she started administration of SBP-101 combined with nab-paclitaxel and gemcitabine to treat her malignancy. Baseline ophthalmological examination showed bilateral healthy retina an 20/20 visual acuity (VA). After the second monthly cycle of SBP-101, the patient experienced significant visual loss in both eyes, with VA decreasing to 20/50 in right eye (RE) and to 20/40 in left eye (LE). In the suspect of a cancer associated retinopathy (CAR), the patient underwent bilateral injection of intravitreal slow-releasing dexamethasone, with poor clinical outcomes. Concomitant testing for anti-enolase and anti-recoverin antibodies gave negative results, while electroretinography showed borderline but within the limit values in both eyes. At 6 months, VA was 20/5000 in RE and 20/4000 in LE and the patient referred significant limitations in everyday life. Ultra-wide field fundus photography showed a bilateral, roundish area of irregular pigment loss involving the entire macula and extending beyond the arcades. Ultra-wide autofluorescence showed a central area of hypo-autofluorescence surrounded by a ring of alternating hyper- and hypo-autofluorescence areas. Optical coherence tomography showed bilateral atrophy of the subfoveal RPE and disruption of the ellipsoid zone. Optic disc examination was within the limits. No treatment was possible.
In conclusion, ophthalmologists should be aware of the existence of a sight-threatening side effect of SPB-101 administration, since we highlighted a massive bilateral RPE atrophy rapidly developing after the second drug injection.
我们报告一例由SBP - 101引起的视网膜毒性病例，SBP - 101是一种用于治疗转移性胰腺腺癌的多胺抑制剂，在一名无眼部病史的患者中表现为快速进展的双侧中心视网膜色素上皮（RPE）萎缩。
一名患有转移性胰腺腺癌的69岁女性患者前往我们的视网膜诊所，提及有6个月的视力模糊和进行性视野缺损病史。一年前，她开始使用SBP - 101联合纳米白蛋白结合型紫杉醇和吉西他滨治疗其恶性肿瘤。基线眼科检查显示双侧视网膜健康，视力（VA）为20/20。在第二个月的SBP - 101治疗周期后，患者双眼出现明显视力丧失，右眼视力降至20/50，左眼视力降至20/40。怀疑患有癌症相关性视网膜病变（CAR），患者接受了双侧玻璃体内缓释地塞米松注射，但临床效果不佳。抗烯醇化酶和抗恢复蛋白抗体的同步检测结果为阴性，而视网膜电图显示双眼临界但在限值范围内。6个月时，右眼视力为20/5000，左眼视力为20/4000，患者称日常生活受到严重限制。超广角眼底摄影显示双侧圆形不规则色素脱失区域，累及整个黄斑并延伸至视网膜血管弓以外。超广角自发荧光显示中央低自发荧光区域被一圈交替的高自发荧光和低自发荧光区域环绕。光学相干断层扫描显示双侧黄斑下RPE萎缩和椭圆体带破坏。视盘检查在正常范围内。无法进行治疗。
总之，眼科医生应意识到使用SPB - 101存在威胁视力的副作用，因为我们强调了在第二次药物注射后迅速出现的大量双侧RPE萎缩。
