Ocular Microbiology and Immunology Group
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2015 OMIG Abstract 23

Initiation of systemic anti-neoplastic agents contributing to corneal transplant rejection? A case series
A. Rohr, A. Schrier
Manhattan Eye, Ear, and Throat Hospital, Northshore-LIJ Health System
Department of Ophthalmology, New York, NY

Purpose: To report a case series of three patients that presented with episodes of corneal transplant rejection after recent initiation of systemic anti-neoplastic agents for various types of malignancies.

Methods: Case 1 is an 85 year-old female with a history of Descemet’s stripping automated endothelial keratoplasty in the right eye in 2012 for pseudophakic bullous keratopathy. She presented in July 2015 complaining of decreased vision in the right eye after initiation of systemic chemotherapy (platinum/taxane compounds) for metastatic ovarian cancer. Exam was significant for decreased visual acuity of 20/150 (baseline 20/50) and 3+ corneal edema. Case 2 is a 60 year-old female with history of a penetrating keratoplasty in the left eye for keratoconus in 1997. She presented in April 2015 complaining of irritation in the left eye after starting immunotherapy (NYESO1) for melanoma. Visual acuity was 20/40 (baseline 20/30) with trace cell and keratic precipitates on left eye anterior segment exam. Case 3 is a 68 year-old female with history of bilateral penetrating keratoplasties in the 1970s for keratoconus, with repeat penetrating graft in the left eye in 2006. In June 2012, she complained of decreased vision in both eyes after initiation of hormone therapy (tamoxifen) for breast cancer. Exam demonstrated visual acuity of 20/500 and 20/70 in the right and left eyes respectively, (baseline of 20/80, 20/50) bilateral corneal edema and AC reaction.

Results:  All three cases were diagnosed with corneal transplant rejection (1 DSAEK, 3 PKs) within 4 weeks of initiation of various systemic anti-neoplastic therapies (chemotherapy, immunotherapy and hormonal therapy). All cases of rejection were treated with topical prednisolone acetate 1% four times a day in the affected eye +/- muro 128. Case 2 and 3 grafts recovered with treatment; Case 1 follow-up is pending.

Conclusions: Patients with a history of a corneal transplant that plan to start systemic anti-neoplastic therapy may be at greater risk for rejection episodes. Close ophthalmology follow-up shortly after initiation of anti-cancer therapy may be warranted.
Disclosure: N

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