Acute Macular Neuroretinopathy Associated With an Oral FLT3 Inhibitor

Abstract

the office 3 weeks later, on her return from a cruise. Her visual acuity was 20/200 OU. An anterior segment examination was clinically significant for keratic precipitates. Posteriorly, minimal vitreous cells were noted, with clinically significant boxcarring of the retinal arteries (Figure 1). Fluorescein angiography was performed. Early-phase angiogram images are notable for vascular pruning and arterial and venous filling defects (Figure 2). Retinal ischemia with nonperfusion and late disc leakage were noted on later images of the angiogram (Figure 2). A vitreous sample was taken and sent for a Gram stain, bacterial and fungal cultures, and a viral polymerase chain reaction. All had negative findings. Her left eye was unremarkable.This constellation of findings on examination and angiography was consistent with an occlusive retinal vasculitis. She started receiving difluprednate 4 times a day and 40 mg of prednisone per day, without visual improvement at a 2-week follow-up. She subsequently tapered off of both drugs.This was a case of occlusive retinal vasculitis associated with intravitreal administration of brolucizumab in the setting of neovascular age-related macular degeneration. Since brolucizumab was approved for use in the treatment of neovascular age-related macular degeneration in October 2019, there have been reports of clinically significant intraocular inflammation and occlusive retinal vasculitis. The incidence of these events in clinical practice remains unknown at this time, to my knowledge. However, in a phase 3 clinical trial, 1 brolucizumab had an overall 4.4% incidence of intraocular inflammation, with 6 patients diagnosed with a retinal artery occlusion, embolism, or thrombosis. Although it is impossible to confirm the association of this occlusive vasculitis with the medication, this patient's temporal association of administration of the drug with visual acuity loss is notable.

Considering Sex and Gender in Therapeutics throughout the Product Life Cycle: A Narrative Review and Case Study of Gilteritinib

“…Of the 3 included studies, one was a case report of acute macular neuroretinopathy associated with gilteritinib in a 28-year-old female, with improvement in the scotoma and optical coherence tomography 3 months after gilteritinib was switched to azacitidine and midostaurin. 11 Another case report described Sweet syndrome in a 55-year-old female who presented with neutrophilic dermatosis after 4 weeks of gilteritinib therapy for AML. 12 The patient was started on prednisone but experienced flare with tapering.…”

Exogen bedingte Retinopathien

“…Ledipasvir-Sofosbuvir (antivirale Therapie bei chronischer Hepatitis C) kann eine milde posteriore Uveitis auslösen. Die Sonderform einer Uveitis, eine akute makuläre Neuroretinopathie (AMN) wurde in Zusammenhang mit der Einnahme von Gliteritinib beobachtet [27].…”