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A 65-year-old white woman with stage IV breast cancer with metastases to the lungs and liver presented with a new onset of what she called “multiple green spots” in both eyes for 3 days. The spots were stationary; she denied any floaters or photopsias. The onset was simultaneous in both eyes, with no associated eye pain or photophobia. There was no ocular history, and a recent comprehensive eye examination had normal results. Her visual acuity was 20/20 OU. An anterior segment examination had unremarkable results. There was no vitritis, and her optic nerves were pink and sharp. A dilated fundus examination revealed multifocal, hypopigmented, cream-colored spots scattered throughout the posterior pole in both eyes. These spots were hyperautofluorescent on fundus autofluorescence and localized to the subretinal space (Figure 1). Notably, 2 weeks prior to presentation, she had started taking cobimetinib therapy as part of a clinical trial for her breast cancer.
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Mitogen-activated protein kinase kinase (MEK) inhibitor–associated retinopathy
D. Elect observation
This patient had a multifocal distribution of serous retinal detachments throughout the posterior pole in both eyes, which is classic for mitogen-activated protein kinase kinase (MEK) inhibitor–associated retinopathy (MEKAR). This is a well-known potential ocular adverse effect in patients undergoing treatment for metastatic cutaneous melanoma and other malignant conditions.1,2 Classically, presentation consists of bilateral, multifocal fluid pockets in the subretinal space with intact retinal pigment epithelium. Incidence of serous retinopathy in this setting has been reported as high as 90%, although only a minority of these patients become symptomatic.3 The onset of symptoms, which are typically mild and transient, ranges from a few hours to weeks after starting treatment.4 Best-corrected visual acuity typically returns to its baseline level following the resolution of fluid.5
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Corresponding Author: Shriji N. Patel, MD, Vanderbilt Eye Institute, 2311 Pierce Ave, Nashville, TN 37232 (email@example.com).
Published Online: February 6, 2020. doi:10.1001/jamaophthalmol.2019.5288
Conflict of Interest Disclosures: Dr Patel reported grant support from Alcon. No other disclosures were reported.
Additional Contributions: We thank the patient’s spouse for granting permission to publish this information.
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