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Review
. 2021;9(4):168-177.
doi: 10.1007/s40135-021-00277-x. Epub 2021 Dec 21.

Update on Retinal Drug Toxicities

S Tammy Hsu  1 , Arathi Ponugoti  1 , Jordan D Deaner  1 , Lejla Vajzovic  1   2
Affiliations
Review

Update on Retinal Drug Toxicities

S Tammy Hsu et al. Curr Ophthalmol Rep. 2021.

Abstract

Purpose of review: This review aims to provide an update on the clinical presentations and diagnostic findings of drug-induced retinal toxicities.

Recent findings: Several newly FDA-approved medications have been associated with acute retinal toxicities, including brolucizumab, MEK inhibitors, ulixertinib, and FGFR inhibitors. Additionally, as previously believed-to-be well-tolerated medications, such as pentosan sulfate sodium, anti-retroviral therapies, and certain intraoperative ocular medications, are used more frequently or for longer periods of time, associated toxic retinopathies and inflammatory reactions have been reported. Finally, advances in ocular imaging have revealed novel findings in hydroxychloroquine and tamoxifen maculopathies.

Summary: Discovery of new medications, increased frequency of use, and longer-term use have led to increased reports of retinal toxicities. Advances in retinal imaging have allowed for earlier detection of subclinical changes associated with these medications, which may help prevent progression of disease. However, more research is needed to determine the point at which vision loss becomes irreversible. Risks and benefits must be assessed prior to discontinuation of the offending, but potentially lifesaving, therapy.

Keywords: Drug-induced maculopathy; Drug-induced retinopathy; Hemorrhagic occlusive retinal vasculitis, Brolucizumab, Pentosan sulfate; Retinal toxicity; Toxic retinopathy.

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Conflict of interest statement

Conflict of InterestNone of the authors has disclosures related to the submitted work. Dr. Deaner has the following disclosures outside of the submitted work: Alimera Sciences, Inc.: honoraria. Dr. Vajzovic has the following disclosures outside of the submitted work: Applied Genetic Technologies Corporation (AGTC): investigator; Alcon: investigator, consultant; Aldeyra: investigator; Alimera Sciences: consultant; Allergan — consultant; Aerie: consultant; Baush & Lomb: consultant; Beaver-Visitec International (BVI): consultant; Dutch Ophthalmic Research Center (DORC): consultant; Guidepoint: consultant; Gyroscope/Orbit Biomedical — research grant, consultant; Heidelberg Engineering — investigator, research grant; Janssen Pharmaceutical: consultant; Novartis: investigator, consultant; Oculus Surgical: consultant; Regenxbio: investigator; Roche/Genentech — investigator, consultant; Second Sight — investigator, consultant; Evolve Medical Education: honoraria.

Figures

Fig. 1
Fig. 1
(1A) Autofluorescence (AF) image in a patient with retinal hydroxychloroquine toxicity demonstrates a bull’s eye pattern of hypoautofluorescence in the perifoveal area, consistent with EZ loss seen in corresponding optical coherence tomography (OCT) image (1B); note the subfoveal sparing and a rim of hyperautofluorescence on AF. (2A) AF image in a patient with pentosan polysulfate sodium retinal toxicity shows a highly irregular pattern involving a well-defined region in the posterior pole characterized by a network of hyperautofluorescent spots with corresponding OCT (2B) showing patchy retinal pigment epithelium (RPE) loss (images courtesy of Dr. Dilraj Grewal). (3A, 3B) Infrared reflectance (IR) image and corresponding OCT image in a patient with retinal MEK inhibitor toxicity showing subretinal fluid. (4A, 4B) IR and corresponding OCT image in a patient with retinal tamoxifen toxicity demonstrating hyporeflective foveal cavitation and photoreceptor disruption. (5A) Brolucizumab retinal occlusive vasculitis captured on widefield fundus photos, illustrating superior retinal artery sheathing as well as a vitreous opacity; (5B) late-phase FA image demonstrates sclerotic retinal arteries, peripheral nonperfusion, and hyperfluorescence of the optic nerve and perifoveal region (images courtesy of Dr. Glenn Jaffe)
See this image and copyright information in PMC

References

    1. Lenzer J. Covid-19: US gives emergency approval to hydroxychloroquine despite lack of evidence. BMJ. 2020;369:m1335. doi: 10.1136/bmj.m1335. - DOI - PubMed
    1. Skipper CP, et al. Hydroxychloroquine in nonhospitalized adults with early COVID-19. Ann Int Med. 2020;173(8):623–31. doi: 10.7326/m20-4207. - DOI - PMC - PubMed
    1. Yusuf IH, Sharma S, Luqmani R, Downes SM. Hydroxychloroquine retinopathy. Eye. 2017;31(6):828–845. doi: 10.1038/eye.2016.298. - DOI - PMC - PubMed
    1. Downes SM, Leroy BP, Sharma SM, Sivaprasad S, Dollfus H. Hydroxychloroquine hitting the headlines—retinal considerations. Eye. 2020;34(7):1158–1160. doi: 10.1038/s41433-020-0934-9. - DOI - PMC - PubMed
    1. Romano MR, Raimondi R, Montericcio A, Allegrini D. Hydroxychloroquine and ritonavir for COVID-19 infection: a possible synergic toxicity for retinal pigmented epithelium. Graefe’s Archive for Clinical and Experimental Ophthalmology. 2020;258(12):2871. doi: 10.1007/s00417-020-04727-3. - DOI - PMC - PubMed

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