Posters

Corneal cat whiskers caused by Vandetanib: allegory of corneal Verticillata

Poster Details

First Author: D. Ortiz-Vaquerizas SPAIN

Co Author(s):    M. Calatayud                    

Abstract Details

Purpose:

To describe the case of a patient who develops symptomatic corneal verticillata (vortex keratopathy) in both eyes after treatment with vandetanib for medullary thyroid carcinoma with metastases.

Setting:

Corneal verticillata is characterized by the presence of gold greyish subepithelial spiral corneal deposits, ranging swirling towards the periphery, resembling cat's whiskers. They are in the lower cornea, respecting the limbus and visual axis, and the morphology is due to migration pattern of epithelial cells. It rarely causes visual disturbances.

Methods:

A 64-year-old woman complains of bilateral blurred vision and seeing halos around lights for 6 months. Visual acuity is 20/30 and 20/20 in right and left eyes. Only bilateral subepithelial granulate spread over the cornea (cloudy cornea) and vortex keratopathy are found. She denies being treated with amiodarone or antimalarial drugs. However, she has medullary thyroid carcinoma with lung metastases and she is treated with vandetanib 200mg a day for a year. Despite blurred vision, the patient has good life quality, so we agree with oncology to maintain the dose of the drug given the good response of cancer.

Results:

Vortex keratopathy is produced mainly by systemic treatment with amiodarone (in heart diseases) or antimalarials drugs such as chloroquine or hydroxychloroquine (in malaria and autoimmune diseases). There are similar corneal changes in Fabry disease, an inherited metabolic lysosomal storage disorder; a multiple myeloma case report with similar patterns; and two cases treated with vandetanib. Vandetanib is a tyrosine kinase protein inhibitor that binds the epidermal growth factor receptor, which is involved in the epithelial cells migration. It is approved for medullary thyroid cancer treatment, and its use is studied also in non-small cell lung cancer, anaplastic astrocytoma, and breast cancer.

Conclusions:

When corneal verticillata is detected, we should interrogate our patients about treatments with amiodarone, chloroquine or hydroxychloroquine, and the recently added vandetanib, when metabolic disorders have been ruled out (they are usually detected at early ages). Most of the cases have no symptoms, but whether they are symptomatic, we will have to decide with the specialist who introduced the drug if the dose can be lowered or the drug changed, taking in consideration the benefit-risk relation in patient systemic disease.

Financial Disclosure:

NONE