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Chemotherapy-Induced Hyperopic Surprise in a Woman With Multiple Myeloma

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1 Credit CME

A 64-year-old woman presented with worsening vision 4 weeks after a belantamab mafodotin, 2.5 mg/kg, infusion for multiple myeloma. Manifest refraction revealed a bilateral +5-diopter hyperopic shift. Slitlamp microscopy demonstrated peripheral corneal epithelial cystlike changes, previously described with belantamab mafodotin and other chemotherapeutic agents (Figure, A).15 Anterior-segment optical coherence tomography highlighted the cysts as small hyperreflective opacities (Figure, B). Pentacam (Oculus) anterior float maps showed a configuration similar to that seen after myopic laser ablation with central corneal flattening (Figure, B, left inset). Scheimpflug tomography pachymetry and corneal epithelial thickness maps (Figure, B, middle, right inset) revealed this was attributable to relative peripheral corneal epithelial thickening. The belantamab mafodotin infusions were discontinued, leading to normalization of her refractive error and resolution of her microcystic keratopathy within 4 and 6 weeks, respectively. Reduced dosage infusions (1.9 mg/kg) resumed with less dense microcyst recurrence. Rigid gas permeable lenses improved her vision to baseline.

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Article Information

Corresponding Author Address: Gerami D. Seitzman, MD, F. I. Proctor Foundation, University of California, San Francisco, 490 Illinois St, 2nd Floor, San Francisco, CA 94158 (gerami.seitzman@ucsf.edu).

Conflict of Interest Disclosures: Dr Seitzman reported receiving consultant fees from Dompe outside the submitted work. No other disclosures were reported.

Additional Contributions: We thank the patient for granting permission to publish this information.

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Farooq  AV , Degli Esposti  S , Popat  R ,  et al.  Corneal epithelial findings in patients with multiple myeloma treated with antibody-drug conjugate belantamab mafodotin in the pivotal, randomized, DREAMM-2 study.   Ophthalmol Ther. 2020;9(4):889-911. doi:10.1007/s40123-020-00280-8PubMedGoogle ScholarCrossref
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Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

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