Acute bilateral angle closure induced by monoclonal antibody (Daratumumab) infusion

Abstract

Purpose To report a case of daratumumab-induced bilateral angle closure glaucoma and myopia that showed no recurrence after repeated drug administration with prophylactic cycloplegia. Observations A 63-year-old man with relapsing multiple myeloma presented with acute bilateral eye pain and blurred vision 14 hours after first daratumumab infusion. Eye examination revealed raised intraocular pressure and shallow anterior chamber. Anterior segment ocular coherence tomography and ultrasound biomicroscopy showed ciliochoroidal effusions in both eyes. The diagnosis of bilateral acute angle closure glaucoma and induced myopia was made. Cycloplegia- and intraocular-pressure-lowering medications were given, which gradually deepened the anterior chambers and normalized intraocular pressure and refraction. The ciliochoroidal effusions completely resolved on day 14. The cycloplegic was given as a premedication for subsequent infusions. There was no recurrence of effusion throughout his 6-month daratumumab treatment course. Conclusions and importance Daratumumab can induce ciliochoroidal effusion, which results in acute secondary angle closure and myopia. The potential prophylactic effect of the cycloplegic drug may enable continuation of daratumumab infusion under close monitoring.

Transient Daratumumab-Induced Refractive Shift in Multidrug-Resistant Multiple Myeloma: Case Report and Literature Review

“…Conversely, ocular adverse events, such as anterior and intermediate uveitis, bilateral retinal hemorrhages, or optic disc edema, are infrequent, and their pathophysiology is not completely understood [17]. Other cases of acute bilateral angle closure with myopic shift, blurry of distant vision, or acute transient myopia have been described during the first intravenous daratumumab administration [10, 18]. Similar to that reported in literature, also our patient experienced dizziness, mild blurred vision, and headache during the first daratumumab infusion, and was diagnosed with myopic shift with symmetrical decrease in distance UCVA, as reported in a previously published case [9].…”