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Klin Monbl Augenheilkd 2025; 242(10): 1027-1041
DOI: 10.1055/a-2563-4912
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Unerwünschte okuläre Arzneimittelwirkungen von Chemotherapeutika

Visual side effects of chemotherapeutic drugs

Authors

  • Louisa M Bulirsch

  • Karin U. Löffler

  • Matthias Marten Mauschitz

  • Martina C. Herwig-Carl

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Chemotherapeutika können am Auge zu gravierenden Nebenwirkungen führen. Wir stellen einige der für Nebenwirkungen am Auge wichtigsten Chemotherapeutika vor – sowohl solche, die bei Vorliegen einer okulären Neoplasie direkt am Auge angewendet werden, als auch systemisch applizierte. Besonders wichtig ist ein interdisziplinärer Austausch zwischen dem Augenarzt und den behandelnden Fachdisziplinen zur bestmöglichen Versorgung der Patienten.

Abstract

Chemotherapeutic agents can lead to serious visual side effects in the eye, which can affect both the anterior and posterior segment. This article presents a selection of the most important chemotherapeutics causing ocular side effects. We will discuss side effects of chemotherapeutic agents that are applied directly to the eye for the treatment of an ocular neoplasia as well as side effects of systemically applied chemotherapeutic agents. Furthermore, the corresponding therapy and possible necessary adaptions of the chemotherapy are explained. Most importantly the ophthalmologist should stay in close contact with the other treating specialists.

Kernaussagen

  • Man sollte okuläre Nebenwirkungen von topischer und systemischer Chemotherapie unterscheiden.

  • Für die Beurteilung der okulären Veränderungen ist immer auch eine vollständige Anamnese bezüglich der Grunderkrankung und deren Therapie wichtig.

  • Ein enger interdisziplinärer Austausch der behandelnden Fachdisziplinen ist notwendig, um die Patienten bestmöglich zu versorgen.

  • Die Nebenwirkungen können verschiedene Augenabschnitte betreffen und unterschiedlich stark ausgeprägt sein.

  • Die Therapie der Nebenwirkungen sowie die Fortführung der Chemotherapie sind individuell abzustimmen.

Schlüsselwörter

Visusbeeinträchtigung - Keratopathie - Epitheltoxizität - trockenes Auge - Uveitis - RPE-Atrophie

Keywords

visual impairment - keratopathy - epithelial toxicity - dry eye - uveitis - retinal pigment epithelial atrophy


Publication History

Article published online:
23 July 2025

© 2025. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

  • Literatur

  • 1 Kam KW, Di Zazzo A, De Gregorio C. et al. A review on drug-induced dry eye disease. Indian J Ophthalmol 2023; 71: 1263-1269
    Search in Google Scholar
  • 2 Gabison EE, Rousseau A, Labetoulle M. et al. Ocular adverse events associated with antibody-drug conjugates used in cancer: Focus on pathophysiology and management strategies. Prog Retin Eye Res 2024; 103: 101302
    Search in Google Scholar
  • 3 Ando R, Kase S, Ohashi T. et al. Tissue factor expression in human pterygium. Mol Vis 2011; 17: 63-69
    Search in Google Scholar
  • 4 Rudmann DG. On-target and off-target-based toxicologic effects. Toxicol Pathol 2013; 41: 310-314
    Search in Google Scholar
  • 5 Iyer VN, Szybalski W. A molecular mechanism of mitomycin action: linking of complementary DNA-strands. Proc Nat Acad Sci 1963; 50: 355-362
    Search in Google Scholar
  • 6 Höllhumer R, Williams S, Michelow P. Ocular surface squamous neoplasia: management and outcomes. Eye (Lond) 2021; 35: 1562-1573
    Search in Google Scholar
  • 7 Wolters JEJ, van Mechelen RJS, Al Majidi R. et al. History, presence, and future of mitomycin C in glaucoma filtration surgery. Curr Opin Ophthalmol 2021; 32: 148-159
    Search in Google Scholar
  • 8 Lichtinger A, Pe’er J, Frucht-Pery J. et al. Limbal Sstem cell deficiency after topical mitomycin C therapy for primary acquired melanosis with atypia. Ophthalmology 2010; 117: 431-437
    Search in Google Scholar
  • 9 Venkateswaran N, Mercado C, Galor A. et al. Comparison of topical 5-fluorouracil and interferon alfa-2b as primary treatment modalities for ocular surface squamous neoplasia. Am J Ophthalmol 2019; 199: 216-222
    Search in Google Scholar
  • 10 Al-Barrag A, Al-Shaer M, Al-Matary N. et al. 5-fluorouracil for the treatment of intraepithelial neoplasia and squamous cell carcinoma of the conjunctiva, and cornea. Clin Ophthalmol 2010; 4: 801-808
    Search in Google Scholar
  • 11 Parrozzani R, Frizziero L, Trainiti S. et al. Topical 1% 5-fluoruracil as a sole treatment of corneoconjunctival ocular surface squamous neoplasia: Long-term study. Br J Ophthalmol 2017; 101: 1094-1099
    Search in Google Scholar
  • 12 Knapp A, Heuer DK, Stern GA. et al. Serious corneal complications of glaucoma filtering surgery with postoperative 5-fluorouracil. Am J Ophthalmol 1987; 103: 183-187
    Search in Google Scholar
  • 13 Jiang J, Böhringer D, Auw-Hädrich C. et al. Current practice in the treatment of epithelial and melanocytic tumours with interferon- α 2b: A survey of tertiary eye centres in Germany. Klin Monbl Augenheilkd 2022; 240: 891-896
    Search in Google Scholar
  • 14 Karp CL, Anat G, Yunhee L. et al. Pegylated interferon alpha 2b for treatment of ocular surface squamousn: A pilot study. Ocul Immunol Inflamm 2010; 18: 254-260
    Search in Google Scholar
  • 15 Nuruddin M, Roy SR, Hoque F. Pegylated interferon-alpha-2a for the treatment of ocular surface squamous neoplasia. Oman J Ophthalmol 2022; 15: 81-84
    Search in Google Scholar
  • 16 Zanaty M, Barros G, Chalouhi N. et al. Update on intra-arterial chemotherapy for retinoblastoma. ScientificWorldJournal 2014; 2014: 869604
    Search in Google Scholar
  • 17 Gombos DS, Hungerford J, Abramson DH. et al. Secondary acute myelogenous leukemia in patients with retinoblastoma: Is chemotherapy a factor?. Ophthalmology 2007; 114: 1378-1383
    Search in Google Scholar
  • 18 Yousef YA, Al Jboor M, Mohammad M. et al. Safety and efficacy of intravitreal chemotherapy (Melphalan) to treat vitreous seeds in retinoblastoma. Front Pharmacol 2021; 12: 296787
    Search in Google Scholar
  • 19 Yousef YA, Noureldin AM, Sultan I. et al. Intravitreal melphalan chemotherapy for vitreous seeds in retinoblastoma. J Ophthalmol 2020; 2020
    Search in Google Scholar
  • 20 Solaz-Ruiz MG, Pérez LA, Cauto Picazo C. et al. Toxicity to intravitreal melphalan in a patient with retinoblastoma. Rom J Ophthalmol 2023; 67: 305-308
    Search in Google Scholar
  • 21 Shields CL, Manjandavida FP, Arepalli S. et al. Intravitreal melphalan for persistent or recurrent retinoblastoma vitreous seeds: Preliminary results. JAMA Ophthalmol 2014; 132: 319-325
    Search in Google Scholar
  • 22 Francis JH, Marr BP, Brodie SE. et al. Anterior ocular toxicity of intravitreous melphalan for retinoblastoma. JAMA Ophthalmol 2015; 133: 1459-1463
    Search in Google Scholar
  • 23 Eagle RC, Shields CL, Bianciotto C. et al. Histopathologic observations after intra-arterial chemotherapy for retinoblastoma. Arch Ophthalmol 2011; 129: 1416-1421
    Search in Google Scholar
  • 24 Abdi F, Mohammadi SS, Falavarjani KG. Intravitreal methotrexate. J Ophthalmic Vis Res 2021; 16: 657-669
    Search in Google Scholar
  • 25 Frenkel S, Hendler K, Siegal T. et al. Intravitreal methotrexate for treating vitreoretinal lymphoma: 10 years of experience. Br J Ophthalmol 2008; 92: 383
    Search in Google Scholar
  • 26 Boucher R, Haigh O, Barreau E. et al. Ocular surface toxicities associated with modern anticancer therapies. Surv Ophthalmol 2024; 69: 198-210
    Search in Google Scholar
  • 27 Lonial S, Lee HC, Badros A. et al. Belantamab mafodotin for relapsed or refractory multiple myeloma (DREAMM-2): a two-arm, randomised, open-label, phase 2 study. Lancet Oncol 2020; 21: 207-221
    Search in Google Scholar
  • 28 Dimopoulos MA, Hungria VTM, Radinoff A. et al. Efficacy and safety of single-agent belantamab mafodotin versus pomalidomide plus low-dose dexamethasone in patients with relapsed or refractory multiple myeloma (DREAMM-3): a phase 3, open-label, randomised study. Lancet Haematol 2023; 10: e801-e812
    Search in Google Scholar
  • 29 Wahab A, Rafae A, Mushtaq K. et al. Ocular toxicity of belantamab mafodotin, an oncological perspective of management in relapsed and refractory multiple myeloma. Front Oncol 2021; 11: 678634
    Search in Google Scholar
  • 30 Farooq AV, Degli Esposti S, Popat R. et al. Corneal epithelial findings in patients with multiple myeloma treated with antibody-drug conjugate belantamab mafodotin in the pivotal, randomized, DREAMM-2 study. Ophthalmol Ther 2020; 9: 889-911
    Search in Google Scholar
  • 31 Baines AC, Ershler R, Kanapuru B. et al. FDA approval summary: Belantamab mafodotin for patients with relapsed or refractory multiple myeloma. Clin Cancer Res 2022; 28: 4629-4633
    Search in Google Scholar
  • 32 Schloesser L, Loeffler KU, Heine A. et al. Dynamics of microcyst-like epithelial changes associated with Belantamab mafodotin therapy in a patient with multiple myeloma—a case report. Blood Cancer J 2024; 14: 133
    Search in Google Scholar
  • 33 Rousseau A, Michot J-M, Labetoulle M. Belantamab mafotodin-induced epithelial keratopathy masquerading myopic surgery. Ophthalmology 2020; 127: 1626
    Search in Google Scholar
  • 34 Chauvier J, Trone M-C, Gain P. et al. Corneal Toxicity in Patients Treated by BELANTAMAB MAFODOTIN: How to Improve and Facilitate Patients Follow-Up Using Refractive Shift?. J Ocul Pharmacol Ther 2024; 40: 410-418
    Search in Google Scholar
  • 35 Matulonis UA, Lorusso D, Oaknin A. et al. Efficacy and Safety of Mirvetuximab Soravtansine in Patients With Platinum-Resistant Ovarian Cancer With High Folate Receptor Alpha Expression: Results From the SORAYA Study. J Clin Oncol 2023; 41: 2436-2445
    Search in Google Scholar
  • 36 Aschauer J, Donner R, Lammer J. et al. Corneal toxicity associated with belantamab mafodotin is not restricted to the epithelium: neuropathy studied with confocal microscopy. Am J Ophthalmol 2022; 242: 116-124
    Search in Google Scholar
  • 37 Parikh AA, Hanna J, Shah AP. Acute keratoconjunctivitis associated with tisotumab vedotin-tftv for metastatic cervical cancer. Am J Ophthalmol Case Rep 2024; 33: 101979
    Search in Google Scholar
  • 38 Bouguerra Zina B, Rousseau F, Fauquier S. et al. Practical clinical management of ocular adverse events related to Antibody-Drug Conjugates in gynaecological malignancies. Cancer Treat Rev 2025; 134: 102867
    Search in Google Scholar
  • 39 Thurau S, Wildner G, Gamulescu MA. Ocular side effects of modern oncological therapy: Immunological checkpoint and MEK/BRAF signal transduction inhibitors. Ophthalmologie 2023; 120: 559-573
    Search in Google Scholar
  • 40 Jeng-Miller KW, Miller MA, Heier JS. Ocular Effects of MEK inhibitor therapy: Literature review, clinical presentation, and best practices for mitigation. Oncologist 2024; 29: e616-e621
    Search in Google Scholar
  • 41 Sommer M, Werkl P, Singer C. et al. Panuveitis under dabrafenib/trametinib treatment for malignant cutaneous melanoma persisting after completion of treatment. Ophthalmologie 2024; 121: 842-844
    Search in Google Scholar
  • 42 Young L, Finnigan S, Streicher H. et al. Ocular adverse events in PD-1 and PD-L1 inhibitors. J Immunother Cancer 2021; 9: e002119
    Search in Google Scholar
  • 43 Masalkhi M, Wahoud N, Moran B. et al. Impact of immune checkpoint inhibitors on vision and eye health. Eye (Lond) 2024; 38: 2854-2856
    Search in Google Scholar
  • 44 Su Y, Li G, Xu J. et al. Immune-related keratitis is a rare complication associated with nivolumab treatment in a patient with advanced colorectal cancer: A case report. Front Oncol 2022; 12: 1021713
    Search in Google Scholar
  • 45 Zubair AS, Roy B, Baehring JM. et al. Myasthenia gravis in the setting of immune checkpoint inhibitor therapy: Practical considerations and opinion-based approach to acute management. Cureus 2022; 14: e30638
    Search in Google Scholar
  • 46 Dalvin LA, Shields CL, Orloff M. et al. Checkpoint inhibitor immune therapy: Systemic indications and ophthalmic side effects. Retina 2018; 38: 1063-1078
    Search in Google Scholar
  • 47 Dimitriou F, Urner-Bloch U, Eggenschwiler C. et al. The association between immune checkpoint or BRAF/MEK inhibitor therapy and uveitis in patients with advanced cutaneous melanoma. Eur J Cancer 2021; 144: 215-223
    Search in Google Scholar
  • 48 Meinke J, Adamson MS, Saßmannshausen M. et al. Bilateral choroidal detachment and hypotension under treatment with checkpoint inhibitors. Ophthalmologie 2024; 121: 985-989
    Search in Google Scholar
  • 49 Sun MM, Levinson RD, Filipowicz A. et al. Uveitis in patients treated with CTLA-4 and PD-1 checkpoint blockade inhibition. Ocul Immunol Inflamm 2020; 28: 217-227
    Search in Google Scholar
  • 50 Bazvand F, Mahdizad Z, Mohammadi N. et al. Tamoxifen retinopathy. Surv Ophthalmol 2023; 68: 628-640
    Search in Google Scholar
  • 51 Kaiser-Kupfer M, Lippman M. Tamoxifen retinopathy. Cancer Treat Rep 1978; 62: 315-320
    Search in Google Scholar
  • 52 Arora S, Surakiatchanukul T, Arora T. et al. Retinal toxicities of systemic anticancer drugs. Surv Ophthalmol 2022; 67: 97-148
    Search in Google Scholar
  • 53 Colley SM, Elston JS. Clinical case notes. Clin Exp Ophthalmol 2004; 32: 105-106
    Search in Google Scholar
  • 54 Tenney S, Oboh-Weilke A, Wagner D. et al. Tamoxifen retinopathy: A comprehensive review. Surv Ophthalmol 2024; 69: 42-50
    Search in Google Scholar