Ophthalmological complications of antitumor therapy in patients with oncological diseases of various localizations

The current level of care for patients with cancer allows them to achieve remission or recovery in cases previously considered incurable. At the same time, the experience of possible side effects affecting the quality of life of patients is accumulating. In recent years, complications from the organ of vision have been described in the literature, affecting both the anterior segment of the eye, as well as the retina and optic nerve. The aim of the work is to analyze the features of the side effects of antitumor therapy of oncological diseases of various localization on the part of the organ of vision using clinical examples. Two cases of chemotherapy complications have been described: in breast cancer using tamoxifen, in diffuse B-cell lymphoma with bone marrow damage during vincristine therapy. The side effects of tamoxifen were characterized by a decrease in visual acuity in combination with crystalline deposits on the retina by the type of star shape, edema of the optic disc. The use of steroid therapy had a positive effect, visual acuity increased. The use of vincristine in the second clinical example led to damage to the optic nerve by the type of papillitis. The therapy did not lead to an increase in vision. The complications associated with vincristine therapy are dosedependent, timely withdrawal of the drug could preserve visual functions. Conclusion: the most toxic antitumor drugs for the organ of vision are alkylating agents, antimetabolites, mitosis inhibitors, hormonal agents, monoclonal antibodies, protein kinase inhibitors. The interaction between oncologists and ophthalmologists can maintain a high quality of life for patients with cancer.

1. Asencio-Durán M, Fernández-Gutiérrez E, Larrañaga-Cores M, et al. Ocular side effects of oncological therapies: Review. Archivos de la Sociedad Española de Oftalmología (English Edition), 2024; 99 (3): 109–32. https://doi.org/10.1016/j.oftale.2023.11.003

2. Muftakhova G.M., Grachev N.S., Ushakova T.L., Gorbunova T.V., Pershin B.S. Late effects on the organs of hearing and vision. Russian journal of pediatric hematology and oncology. 2020; 3 (7): 150–6 (In Russ.).

3. Ma J, Pazo EE, Zou Z, Jin F. Prevalence of symptomatic dry eye in breast cancer patients under going systemic adjuvant treatment: Across-sectional study. The breast. 2020; 53: 164–71. https://doi.org/10.1016/j.breast.2020.07.009

4. Salmon D.F. Kansky’s Clinical Ophthalmology. A Systematic Approach. Neroev V. V., ed. 9th ed. Moscow: OOO “Izdatelstvo “Medical Information Agency”. 2023: 955–7 (In Russ.).

5. Altynbaeva G.R., Azamatova G.A., Gilvanova A.A., Khaidarov I. Kh. Experience in treating secondary dry eye syndrome caused by ectropion of the eyelids during chemotherapy in a patient with a malignant neoplasm of the rectum. Saratov scientific medical journal. 2021; 17 (2): 266–8 (In Russ.).

6. Kunitskaya N.A. Development of complicated dry eye syndrome during treatment of lung malignancy: A case from practice. Magyar Tudomanyos Journal. 2020; 46: 19–21 (In Russ.).

7. Ho WL, Wong H, Yau T. The ophthalmological complications of targeted agents in cancer therapy: What do we need to know as ophthalmologists? Acta Ophthalmol. 2013, 91, 604–9. https://doi.org/10.1111/j.1755-3768.2012.02518.x

8. Singh P, Singh A. Ocular adverse effects of anti-cancer chemotherapy. Journal of cancer therapeutics and research. January 2012; 1 (1): 5. doi: 10.7243/2049-7962-1-5

9. DiStaso F, Gattazzo I, Taurelli Salimbeni B, et al. Treatment of capecitabine corneal side effects with autologous blood-derived serum eye drops. In Vivo. 2021 May-Jun; 35 (3): 1881–4. https://doi.org/10.21873/invivo.12451

10. Qian Chen, Chaoyi Feng, Chuanbin Sun, et al. Cancer-associated retinopathy after anti-programmed death 1 (PD-1) antibody for treating hepatocellular carcinoma — a case report of a Chinese patient. Am J Ophthalmol Case Rep. 2022 Jan 29; 25: 101370. https://doi.org/10.1016/j.ajoc.2022.101370

11. Wilding G, Caruso R, Lawrence TS, et al. Retinal toxicity after high-dose cisplatin therapy. J Clin Oncol. 1985 Dec; 3 (12): 1683–9. doi: 10.1200/JCO.1985.3.12.1683

12. Stoicescu EA, Iancu RC, Popa Cherecheanu A, Iancu G. Ocular adverse effects of anti-cancer chemotherapy. J Med Life. 2023 Jun; 16 (6): 818–21. https://doi.org/10.25122/jml-2023-0041

13. Sodhi M, Yeung SN, Maberley D, Mikelberg F, Etminan M. Risk of ocular adverse events with Taxane-based chemotherapy. JAMA Ophthalmol. 2022 Sep 1; 140 (9): 880–4. https://doi.org/10.1001/jamaophthalmol.2022.3026

14. Ritter C, Renner AB, Wachtlin J, Bechrakis NE, Krause L. [Tamoxifen retinopathy: A case series of clinical and functional data]. Ophthalmologe. 2008; 105: 544–9. https://doi.org/10.1007/s00347-007-1677-8

15. Lee WH, You SK, Lee YH. Bilateral optic neuropathy following vincristine chemotherapy: A case report with description of multimodal imaging findings. Medicine (Baltimore). 2021 Mar 5; 100 (9): e24706. https://doi.org/10.1097/md.0000000000024706