Rapid vision loss associated with fludarabine administration.
OBJECTIVE
The purpose of this study was to report the clinical and pathologic findings of three cases of rapid vision loss associated with fludarabine toxicity.


METHODS
A retrospective, single-center case series was conducted. Autopsies of the eyes from three cases were performed.


RESULTS
A 23-year-old man (Case 1) with systemic lupus erythematosus developed rapid and severe vision loss, generalized neurologic decline, and eventual death after administration of fludarabine before stem cell transplantation. A 48-year-old woman (Case 2) and a 60-year-old man (Case 3), both with metastatic melanoma, had similar courses after receiving fludarabine as part of a preparatory regimen before adoptive cell therapy. Fundus examination showed punctuate yellow flecks in the macula after visual decline in two cases. In all three cases, serum antiretinal antibodies were negative before and after treatment; electrophysiological testing showed markedly decreased B-waves; and pathologic analysis showed loss of retinal bipolar and ganglion cells, gliosis within the retina and optic nerve, and optic nerve atrophy.


CONCLUSIONS
Fludarabine toxicity can result in severe vision loss attributable to damage to retinal bipolar and ganglion cells. Although effective treatments are not known, care should be taken to consider fludarabine toxicity in patients who present with vision loss approximately 1 month after treatment.
National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA. bishopra@nei.nih.gov
Rachel J
RJ
Bishop
Xiaoyan
X
Ding
Charles K
CK
Heller
Gabor
G
Illei
Rafael  C
R
Caruso
Denise
D
Cunningham
Steven
S
Pavletic
Chi-Chao
CC
Chan
D000970:Antineoplastic Agents / Q000009:adverse effects*; D001766:Blindness / Q000139:chemically induced* / Q000503:physiopathology; D001927:Brain Diseases / Q000139:chemically induced / Q000175:diagnosis; D004596:Electroretinography; D005074:Evoked Potentials, Visual; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D008545:Melanoma / Q000188:drug therapy / Q000556:secondary; D008875:Middle Aged; D019653:Myeloablative Agonists / Q000009:adverse effects; D012160:Retina / Q000187:drug effects / Q000503:physiopathology; D012164:Retinal Diseases / Q000139:chemically induced* / Q000175:diagnosis; D012189:Retrospective Studies; D014740:Vidarabine / Q000009:adverse effects / Q000031:analogs & derivatives*; D055815:Young Adult
D000970:Antineoplastic Agents; D019653:Myeloablative Agonists; D014740:Vidarabine; C024352:fludarabine