First Author: J.Maya UK
Co Author(s): K. Balaggan
Back to previous
This is the first case report in the literature that present a clinical response of DMO in a patient on a systemic tyrosine kinase inhibitor for an non related ocular condition.
A non-well controlled diabetic had history of metastatic renal cell carcinoma. He was nephrectomised in 2008 and received radiotherapy in 2012. On the clinical examination presented a bilateral mild lens opacification and the funduscopic exam a mild non-proliferative diabetic retinopathy with centre and non-centre involved DMO in right and left eye. A close follow up was organized. Three months later the patient came back with a subjective improvement of vision in the right eye, the visual acuity was of 20/50 and 20/25 in right and left eye. The functional improvement was associated with a resolution of the DMO in both eyes. In the following investigations it was noticed that the patient had started Axitinib 5mg BD as part of complementary treatment for the renal cell carcinoma. The diabetic control was very poor and no other interventions for the macular edema were documented during the time frame.
Axitinib modulates it action from the binding to the kinase domain of VEGF receptors, stabilizing the inactive configuration of the kinase that leads to the inhibition of the signal transduction for VEGF (VEGFR-1, -2 and -3), also inhibiting PDGFR α-β, and c-KIT. The anti-angiogenic properties of Axitinib in DMO were previously investigated in human retinal-pigmented epithelium and human vein endothelial cells exposed to hypoxia. Although the in vitro results gave the initial evidence that the drug might be a potential treatment of DMO, non other related studies in this matter has been reported since. In this patient the anatomical response and the visual improvement in this patient resemble those mediated to anti-VEGF therapy.