IMAGE OF THE MONTH: May 2022

Retinal Blebs

Abdulla Shaheen, MD and Nicolas Yannuzzi, MD (Bascom Palmer Eye Institute)

55 year old Caucasian female with a history of bladder cancer was referred for retinal abnormalities. VA 20/25 and 20/30

DIAGNOSIS


Differential Diagnosis

  • Central serous chorioretinopathy
  • Medication toxicity

Definitive Diagnosis

  • Fibroblast Growth Factor Receptor (FGFR) Inhibitor–Associated Retinopathy (aka FGFR inhibitor associated pseudocentral chorioretinopathy)


Discussion:

Fibroblast Growth Factor Receptor Antagonists


  • Epidemiology: Few studies on FGFR antagonist associated retinopathy. Francis et al. reported 20 of 146 patients who developed retinopathy as a consequence of FGFR antagonist medication in a case study published in October 2021 in JAMA Ophthalmology.
  • Presentation: asymptomatic or mildly symptomatic subretinal fluid.
  • Clinical Course: self-resolving without medication discontinuation (Francis et al.). However, only few studies have described the condition, and all were retrospective.
  • Management: No RCTs to guide best therapeutic strategy but liaising with the oncologist is the best current option.
  • Side Notes: The retinopathy seen with FGFR inhibitors is very similar to that shown with MEK and ERK inhibitors.
  • Both have bilateral serous elevations that often surround the fovea.
  • Fluid accumulates between the retinal pigment epithelium and the interdigitation zone on OCT.

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