Anterior chamber fibrinoid syndrome after cataract extraction in a patient on ibrutinib for B-cell chronic lymphocytic leukemia: a case report and review of the literature
- PMID: 30442199
- PMCID: PMC6238337
- DOI: 10.1186/s13256-018-1822-9
Anterior chamber fibrinoid syndrome after cataract extraction in a patient on ibrutinib for B-cell chronic lymphocytic leukemia: a case report and review of the literature
Abstract
Background: Ibrutinib is a tyrosine kinase inhibitor commonly used in patients with chronic lymphocytic leukemia. Based on the published literature, it has a very sound ophthalmologic safety profile. In the following, we describe a case of anterior chamber fibrinoid syndrome in a patient on ibrutinib for B-cell chronic lymphocytic leukemia after uncomplicated cataract extraction.
Case presentation: A 75-year-old white man with B-cell chronic lymphocytic leukemia on ibrutinib therapy and without significant past ocular history presented 1 day after uncomplicated phacoemulsification with in-the-bag intraocular lens implantation with multiple, discrete, pigmented cords in the anterior chamber. His vision was 20/100 and intraocular pressure was 43 mmHg. There was no hypopyon, hyphema, or cellular reaction. The dilated fundus examination was unremarkable. He was diagnosed as having fibrinoid syndrome and started on topical prednisolone, brimonidine, timolol-dorzolamide, and orally administered acetazolamide. Within 2 weeks, the fibrin cords disappeared completely, vision improved to 20/30, and the intraocular pressure normalized off all medications.
Conclusions: The precise etiology of fibrinoid syndrome remains unclear. This is the first case of fibrinoid syndrome in a patient on ibrutinib, which is known to cross the blood-brain barrier and induce intraocular changes. It is important to differentiate this syndrome from toxic anterior segment syndrome and endophthalmitis, and to initiate appropriate treatment. The fibrin bands tend to be exquisitely sensitive to topical steroids and to resolve within a few weeks without sequelae.
Keywords: Anterior chamber; Chronic lymphocytic leukemia; Fibrinoid reaction; Fibrinoid syndrome; Ibrutinib; Phacoemulsification.
Conflict of interest statement
Ethics approval and consent to participate
This study conforms to the Health Insurance Portability and Accountability Act (HIPAA) and adheres to the Declaration of Helsinki and all applicable state and federal laws. Approval was not required as this is a case report of one patient.
Consent for publication
Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
Competing interests
The authors declare that they have no competing interests.
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Figures
Similar articles
-
Ibrutinib-associated tumor lysis syndrome in chronic lymphocytic leukemia/small lymphocytic lymphoma and mantle cell lymphoma: A case series and review of the literature.J Oncol Pharm Pract. 2018 Oct;24(7):544-549. doi: 10.1177/1078155217718617. Epub 2017 Jul 16. J Oncol Pharm Pract. 2018. PMID: 28714377 Review.
-
Effect of prophylactic intraocular pressure-lowering medication on pain during cataract surgery.J Ocul Pharmacol Ther. 2013 Sep;29(7):658-62. doi: 10.1089/jop.2012.0244. Epub 2013 Mar 5. J Ocul Pharmacol Ther. 2013. PMID: 23461283 Clinical Trial.
-
Latanoprost versus timolol gel to prevent ocular hypertension after phacoemulsification and intraocular lens implantation.J Cataract Refract Surg. 2000 Mar;26(3):386-91. doi: 10.1016/s0886-3350(99)00364-8. J Cataract Refract Surg. 2000. PMID: 10713234 Clinical Trial.
-
Descriptive analysis of dosing and outcomes for patients with ibrutinib-treated relapsed or refractory chronic lymphocytic leukemia in a Canadian centre.Curr Oncol. 2019 Oct;26(5):e610-e617. doi: 10.3747/co.26.4957. Epub 2019 Oct 1. Curr Oncol. 2019. PMID: 31708654 Free PMC article.
-
Ibrutinib-associated sever skin toxicity: A case of multiple inflamed skin lesions and cellulitis in a 68-year-old male patient with relapsed chronic lymphocytic leukemia - Case report and literature review.J Oncol Pharm Pract. 2020 Mar;26(2):487-491. doi: 10.1177/1078155219856422. Epub 2019 Jun 19. J Oncol Pharm Pract. 2020. PMID: 31216242 Review.
Cited by
-
Spontaneous Hyphema during Ibrutinib Treatment in a CLL Patient.Case Rep Hematol. 2023 Dec 14;2023:1691996. doi: 10.1155/2023/1691996. eCollection 2023. Case Rep Hematol. 2023. PMID: 38130705 Free PMC article.
-
Intraoperative Fibrinous Reaction During Phacoemulsification With Posterior Chamber Intraocular Lens Implantation.Cureus. 2023 Oct 13;15(10):e46968. doi: 10.7759/cureus.46968. eCollection 2023 Oct. Cureus. 2023. PMID: 38022021 Free PMC article.
-
Molecular and microbiological evidence of bacterial contamination of intraocular lenses commonly used in canine cataract surgery.PLoS One. 2022 Nov 21;17(11):e0277753. doi: 10.1371/journal.pone.0277753. eCollection 2022. PLoS One. 2022. PMID: 36409704 Free PMC article.
References
-
- Sebestyen JG. Fibrinoid syndrome: a severe complication of vitrectomy surgery in diabetics. Ann Ophthalmol. 1982;14:853–856. - PubMed
-
- Machemer R. Vitrectomy: A Pars-Plana Approach. New York: Grune and Stratton Inc; 1975. p. 118.
Publication types
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Medical
Miscellaneous