Risk of retinal vein occlusions in patients taking systemic tyrosine kinase inhibitors

OBJECTIVE: To describe a series of patients who developed retinal vein occlusion (RVO) while undergoing treatment with tyrosine kinase inhibitors (TKIs) for systemic malignancy. METHODS: A retrospective chart review was performed to identify patients at an academic medical centre from 2014 to 2024 who developed an RVO while on TKI therapy. Data collected included demographics, cancer diagnosis, TKI agent and treatment duration, ocular history, and treatment outcomes. Ophthalmic imaging obtained at the time of presentation was reviewed when available to confirm the diagnosis of an RVO. RESULTS: Eleven patients (12 eyes) were identified with an RVO during TKI therapy. The mean age at presentation was 75.9 ± 9.8 years, and 8 patients (72.7%) were male. TKIs included imatinib (n = 3), axitinib (n = 5), ibrutinib (n = 2), and regorafenib (n = 1). RVO developed after a mean duration of 2.8 ± 2.0 years on TKI therapy (range: 0.8-6.5 years). Of the 12 RVOs, 8 were central retinal vein occlusions (CRVOs) and 4 were branch retinal vein occlusions (BRVOs). The mean Naranjo Adverse Drug Reaction Probability Score was 5.2, suggesting a probable link between TKI use and RVO. One patient developed bilateral RVO after continuing regorafenib therapy. CONCLUSIONS: This series highlights a possible association between TKI therapy and RVO, underscoring the need for awareness in patients with vascular risk factors.