Case Series Analysis Of Corneal Changes After Treatment With Novel Targeted Anticancer Agents

Reports of ocular toxicity associated with recently introduced antibody–drug conjugates (ADCs) and targeted therapies are increasing. This study aimed to describe the clinical features of microcyst-like lesions observed in patients treated with belantamab mafodotin for multiple myeloma, ubamatamab for ovarian cancer, and osimertinib for lung cancer, and to report associated changes in corneal topography and refraction.

Retrospective, chart review study

We retrospectively reviewed the medical records of patients who received these agents and were referred for ophthalmic consultation. Corneal findings were assessed by slit-lamp biomicroscopy. Refractive error, corneal topography, and anterior segment OCT were evaluated to compare pre- and post-treatment changes in corneal curvature (K values) and refractive status.

Characteristic microcyst-like lesions were observed in the corneal epithelium of the included patients. The lesions were predominantly distributed in an annular pattern in the cornea mid-periphy. Corneal topography and anterior segment OCT demonstrated a significant increase in SimK values (corneal steepening) compared with baseline. Clinically meaningful myopic shift was observed accordingly and was a major contributor to uncorrected visual acuity decline. These corneal changes appeared to be associated with treatment duration and dose.

Novel anticancer agents, including belantamab mafodotin, ubamatamab, and osimertinib, can induce epithelial microcysts, which may lead to increased corneal curvature and myopic shift. Ophthalmologists should recognize this characteristic complication and, when evaluating visual decline in patients undergoing anticancer therapy, consider treatment-related refractive changes and monitor patients closely.