A denileukin diftitox (Ontak) associated retinopathy?

摘要

Two patients with haematological malignancies presented with visual symptoms during therapy with denileukin diftitox. Both experienced loss of central and colour vision, coarse pigmentary macular changes, and decreased electroretinographic amplitudes. These cases raise the possibility of a novel drug associated retinopathy. A 58 year old man with chronic lymphocytic leukaemia was enroalled in a clinical trial of denileukin diftitox (Ontak, Ligand Pharmaceuticals) receiving 10 standard cycles of therapy with good response. Eight months later his disease progressed and he received four further cycles. During this treatment he noted blurred vision, photopsias and difficulty adjusting to bright lights. Acuity was 6/12 bilaterally and coarse macu-lar pigment changes were present (fig 1). Automated fields showed paracentral scoto-mas and electroretinograms (ERG) revealed delayed and diminished photopic wave forms with preserved scotopic responses. Brain magnetic resonance imaging (MRI) and cerebrospinal fluid (CSF) were normal.