Late Presentation of Pseudophakic Macula Edema from Oral Kinase Inhibitors: A Case Series and Literature Review.

Introduction: Two cases of late presentation (>5 years) of bilateral pseudophakic macula edema related to oral tyrosine kinase inhibitors are described. These cases are the first of their type in the published literature. A review of ocular inflammatory complications of tyrosine kinase inhibitors in the current literature is explored.

Case Presentation: Case 1 is an 83-year-old female who has been stable on ibrutinib (Imbruvica) for chronic lymphocytic leukemia. She presented with bilateral blurred vision from severe cystoid macula edema, 7 years following routine cataract surgery. She was treated with intravitreal steroids with complete resolution without relapse. Case 2 is a 76-year-old female who was on therapy for polycythemia vera with ruxolitinib (Jakafi). She presented with bilateral blurred vision from mild cystoid macula edema, 6 years following routine cataract surgery. She responded well to topical steroids without relapse. In both cases, oral tyrosine kinase inhibitor agents were presumed to be the underlying cause and were ceased. Over the last 5 years, there have been increasing reports in the literature of the inflammatory effects of tyrosine kinase inhibitors on the retina, uvea, and optic nerve.

Conclusion: Late presentation of pseudophakic macula edema following routine cataract surgery is rare. Such presentations should prompt investigation of chronic use of systemic medications, especially oral kinase inhibitors. Patients who must remain on these agents require ongoing ophthalmologic assessment in view of their long-term inflammatory side effects.