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 CRVO

Michael Altman's profile image
Michael Altman posted 09-30-2025 11:59
Hi all
67 yo we follow for OAG
Hx of endometrial CA metastatic
Treated with hystrectomy and  local positive lymph nodes
Now , for last 3 months on
Keytruda (check point inhib) 
and Lenvima (tyrosine kinase (RTK) inhibitor)
No other sig PMH
Developed Ishemic CRVO  after 3rd infusion
Vision down to CF 1'
Is there enough evidence to say 
Besides a few reported cases
Or clinical hunch
To Stop the infusions
In this now monocular patient ?
If so , should I add IV steroids for possible induced 'Vasculitis'
 (VS Thrombo-embolic mechanism)
Rock and a hard place....
Michael
Baltimore
Shikha TALWAR's profile image
Shikha TALWAR

It’s usually difficult to implicate a drug and prove the cause effect relation. One has to rule out all other causes of the adverse effect. 
It’s important in this case to do the MRI brain/ orbit to r/o sheath infiltration as the blood vessels pass through it.Ischemic CRVO is usually associated with RAPD, disc oedema hence the optic nerve involvement may be masked
Typically a drug induced vasculitis will affect the other eye too. The FFA/OCT may pick up the other eye changes if the findings are subtle.

CRVO can be associated with significant macular oedema and haemorrhages which can settle over a period of time and may need intravitreal antivegf injections. It may be too early to call the patient one eyed just yet.

If there’s any evidence of a threat to the other eye on retina work up or autoimmune serology then we may consider intravenous steroids.