Acute Refractive Shifts Associated With Mirvetuximab Soravtansine-Related Keratopathy: A Case Report

To describe acute refractive instability associated with Mirvetuximab soravtansine (MIRV) therapy and highlight implications for cataract assessment and surgical planning. 

Tertiary specialist oncology centre, Royal Marsden Hospital, London, United Kingdom.

This report discusses a 55-year-old female receiving MIRV therapy for platinum-resistant ovarian cancer who presented with bilateral blurred vision following her third treatment cycle. Slit-lamp examination revealed bilateral corneal epithelial microcysts with associated punctate epithelial staining. Refraction demonstrated an acute hyperopic shift from a previously stable refractive baseline, with subsequent fluctuation of up to 5.00 dioptres over two weeks. Corneal tomography showed bilateral irregular anterior corneal curvature changes, without features suggestive of corneal ectasia or stromal thinning. These findings were consistent with MIRV-associated epithelial keratopathy with secondary refractive instability. This female was managed conservatively with topical corticosteroids and preservative-free lubricants, with subsequent improvement in corneal findings and visual symptoms. Planned cataract surgery was deferred due to unstable refraction and ocular surface disturbance at assessment.

MIRV-associated ocular toxicity may present with acute refractive instability during treatment. These refractive shifts appear to be reversible with supportive management, consistent with transient epithelial toxicity rather than permanent corneal structural changes. Recognition of this presentation allows for appropriate patient counselling and reassurance, reduces the risk of diagnostic error and unnecessary investigations, and informs clinical decision-making regarding the timing of elective ocular interventions.