Central retinal vein occlusion (CRVO) and retinal perfusion defects have been described as potential risks associated with systemic tyrosine kinase inhibitor (TKI) therapy, but current evidence is limited to case reports. Therefore, this study aimed to better characterize any associations between systemic TKIs and the risks of retinal artery occlusion (RAO) and retinal vein occlusion (RVO). Retrospective cohort study using multi-institutional electronic health records across the United States. Adults with cancer diagnoses and no prior history of retinal vascular occlusions or maculopathy, based on International Classification of Diseases (ICD) encounter diagnosis codes, were included. Patients with prescriptions for TKIs with and without anti-vascular endothelial growth factor (anti-VEGF) activities were created, and were each compared to matched control patients with non-TKI antineoplastic prescriptions. The study and control cohorts were propensity-score-matched 1:1 based on demographic factors, comorbidities, other antineoplastic therapy, and cancer stages. The matched cohorts were then compared for having new-onset ICD encounter diagnosis codes of any RAO, CRAO, BRAO, RVO, CRVO, and BRVO. Lifetime risks of RAO, CRAO, BRAO, RVO, CRVO, and BRVO were compared via risk ratios (RRs). Rates of these outcomes within three years of antineoplastic initiation were also evaluated via hazard ratios (HRs). Differences in the outcome measures were considered statistically significant if the 95% confidence interval (CI) was ≤0.9 or ≥1.1. While the anytime-risks of having RAOs and RVOs were comparable between the anti-VEGF TKI cohort and controls (each n =6,728), the anti-VEGF TKI cohort had a significant hazard of having CRVO within three years of TKI initiation (HR=2.86, CI=1.44-5.69). In contrast, while the non-anti-VEGF TKI cohort ( n =17,185) had a lower anytime-risk of having RAO (RR=0.61, CI=0.45-0.83) and BRVO (RR=0.51, CI=0.36-0.71) compared to the non-TKI controls ( n =17,185), there was no difference in the HR among outcomes between the two cohorts. Although non-anti-VEGF TKIs may have a more favorable safety profile with respect to BRVO and RAO compared to other antineoplastic therapies, patients initiating anti-VEGF TKIs may warrant closer ophthalmological monitoring for the incidence of CRVO during the first few years of treatment.
Jeong et al. (Sun,) studied this question.