MEK retinopathy: a case report

Cover Page


Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

The problem of adverse side effects affecting various organs and systems in patients receiving molecular targeted therapy for oncological diseases remains relevant. One group of such drugs are inhibitors of the MEK signaling pathway. These antineoplastic agents inhibit the mitogen-activated protein kinases MEK1 and/or MEK2 and are used, among other indications, in the treatment of cutaneous melanoma. In ophthalmology, ocular toxicity associated with MEK inhibitors has been defined as MEK retinopathy—a characteristic binocular toxic retinal lesion with multifocal foci of neuroepithelial retinal detachment resembling mercury droplets, which reduces visual acuity and often resolves spontaneously or upon discontinuation of targeted therapy. This article presents a clinical case of toxic retinopathy in a female patient receiving targeted therapy with trametinib and dabrafenib for the treatment of cutaneous melanoma. The clinical manifestations and diagnostic criteria of MEK retinopathy are described, differential diagnosis with central serous chorioretinopathy is provided, and the results of empirical therapy for this condition are presented, along with insights into its course and response to different treatment methods.

Full Text

Restricted Access

About the authors

Alina P. Kalyuzhnaya

Diagnostic center No. 7 (ophthalmological) for adults and children, Saint Petersburg

Author for correspondence.
Email: apkalyu@mail.ru
ORCID iD: 0009-0006-9969-7216

MD

Russian Federation, Saint Petersburg

Aida A. Shakhnazarova

Diagnostic center No. 7 (ophthalmological) for adults and children, Saint Petersburg

Email: aida66@bk.ru
ORCID iD: 0000-0002-3053-5538

MD, Cand. Sci. (Medicine)

Russian Federation, Saint Petersburg

Andrei S. Pokrovskii

Diagnostic center No. 7 (ophthalmological) for adults and children, Saint Petersburg

Email: pokrovas@gmail.com
ORCID iD: 0009-0004-6916-270X

MD

Russian Federation, Saint Petersburg

References

  1. Stjepanovic N, Velazquez-Martin JP, Bedard PL. Ocular toxicities of MEK inhibitors and other targeted therapies. Ann Oncol. 2016;27(6):998–1005. doi: 10.1093/annonc/mdw100
  2. Duncan KE, Chang LY, Patronas M. MEK inhibitors: a new class of chemotherapeutic agents with ocular toxicity. Eye (Lond). 2015;29(8):1003–1012. doi: 10.1038/eye.2015.82
  3. Yanagihara RT, Tom ES, Seitzman GD, Saraf SS. A case of bilateral multifocal choroiditis associated with BRAF/MEK inhibitor use for metastatic cutaneous melanoma. Ocul Immunol Inflamm. 2022;30(7–8):2005–2009. doi: 10.1080/09273948.2021.1928714
  4. Han J, Chen J, Zhou H, et al. Ocular toxicities of MEK inhibitors in patients with cancer: A systematic review and meta-analysis. Oncology (Williston Park). 2023;37(3):130–141. doi: 10.46883/2023.25920987
  5. Vladimirova LYu. Usage of MEK inhibitors in oncology: results and perspectives. Achievements of modern natural science. 2015;(3):18–30. EDN: UDZVVJ
  6. Urner-Bloch U, Urner M, Stieger P, et al. Transient MEK inhibitor-associated retinopathy in metastatic melanoma. Ann Oncol. 2014;25(7):1437–1441. doi: 10.1093/annonc/mdu169
  7. Maubon L, Hirji N, Petrarca R, Ursell P. MEK inhibitors: a new class of chemotherapeutic agents with ocular toxicity. Eye (Lond). 2016;30(2):330. doi: 10.1038/eye.2015.243
  8. Tyagi P, Santiago C. New features in MEK retinopathy. BMC Ophthalmol. 2018;18(S1):221. doi: 10.1186/s12886-018-0861-8
  9. Francis JH, Habib LA, Abramson DH, et al. Clinical and morphologic characteristics of MEK inhibitor-associated retinopathy: Differences from central serous chorioretinopathy. Ophthalmology. 2017;124(12):1788–1798. doi: 10.1016/j.ophtha.2017.05.038
  10. Fasolino G, Awada G, Moschetta L, et al. Assessment of retinal pigment epithelium alterations and chorioretinal vascular network analyses in patients under treatment with BRAF/MEK inhibitor for different malignancies: A pilot study. J Clin Med. 2023;12(3):1214. doi: 10.3390/jcm12031214
  11. van Dijk EHC, Duits DEM, Versluis M, et al. Loss of MAPK pathway activation in post-mitotic retinal cells as mechanism in MEK inhibition-related retinopathy in cancer patients. Medicine (Baltimore). 2016;95(18):e3457. doi: 10.1097/MD.0000000000003457
  12. Booth AEC, Hopkins AM, Rowland A, et al. Risk factors for MEK-associated retinopathy in patients with advanced melanoma treated with combination BRAF and MEK inhibitor therapy. Ther Adv Med Oncol. 2020;12:1758835920944359. doi: 10.1177/1758835920944359
  13. Pandya BU, Grinton M, Mandelcorn ED, Felfeli T. Retinal optical coherence tomography imaging biomarkers: A review of the literature. Retina. 2024;44(3):369–380. doi: 10.1097/IAE.0000000000003974
  14. Chancellor JR, Kilgore DA, Sallam AB, et al. A Case of non-resolving MEK inhibitor-associated retinopathy. Case Rep Ophthalmol. 2019;10(3):334–338. doi: 10.1159/000503414
  15. Groselli S, Heinrich D, Lohmann CP, Maier M. MEK inhibitor-associated retinopathy under binimetinib treatment for cutaneous malignant melanoma. Der Ophthalmologe. 2021;118(2):169–174. doi: 10.1007/s00347-020-01089-3
  16. Lindboe JB, Ahmed HJ, Christakopoulos CE. Protein kinase inhibitors can induce retinopathy. Ugeskr Laeger. 2020;182(32):V05200303. PMID: 32800052
  17. Murata C, Murakami Y, Fukui T, et al. Serous retinal detachment without leakage on fluorescein/indocyanine angiography in MEK inhibitor-associated retinopathy. Case Rep Ophthalmol. 2022;13(2):542–549. doi: 10.1159/000524558
  18. Rocha Cabrera P, Quijada Fumero E, Losada Castillo MJ, et al. MEK retinopathy. Clinical case reports. Arch Soc Esp Oftalmol (Engl Ed). 2018;93(1):42–46. doi: 10.1016/j.oftal.2017.03.005

Supplementary files

Supplementary Files
Action
1. JATS XML
Download
2. Fig. 1. Photograph of the fundus: a - right eye; b - left eye.

Download (222KB)
Indexing metadata
3. Fig. 2. Optical coherence tomography of the macular region of the right eye.

Download (71KB)
Indexing metadata
4. Fig. 3. Optical coherence tomography of the macular region of the left eye.

Download (74KB)
Indexing metadata
5. Fig. 4. Optical coherence tomography of the retina of the paracentral region (near the vascular arcades) of the right eye.

Download (134KB)
Indexing metadata
6. Fig. 5. Photograph of autofluorescence of the fundus: a - right eye; b - left eye.

Download (257KB)
Indexing metadata
7. Fig. 6. Fluorescein angiography of the fundus: a - right eye; b - left eye.

Download (332KB)
Indexing metadata
8. Fig. 7. Optical coherence tomography of the macular region of the right eye after the introduction of betamethasone No. 1 into the sub-Tenon space.

Download (99KB)
Indexing metadata
9. Fig. 8. Optical coherence tomography of the macular region: a - right eye initially; b - right eye after the introduction of betamethasone No. 2 into the sub-Tenon space.

Download (194KB)
Indexing metadata
10. Fig. 9. Optical coherence tomography of the macular region: a - left eye initially; b - left eye after the introduction of betamethasone No. 1 into the sub-Tenon space.

Download (140KB)
Indexing metadata
11. Fig. 10. Optical coherence tomography of the macular region: a - right eye, after the introduction of betamethasone No. 2 into the sub-Tenon space, discontinuation of targeted therapy; b - left eye, after the introduction of betamethasone No. 1 into the sub-Tenon space, discontinuation of targeted therapy.

Download (147KB)
Indexing metadata
12. Fig. 11. Infrared image of the fundus of the left eye.

Download (253KB)
Indexing metadata

Copyright (c) 2025 Eco-Vector


СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ПИ № ФС 77-65574 от 04 мая 2016 г.