The edition · Ophthalmology
HER2 antibody-drug conjugates damaged the ocular surface in 18 of 21 patients within a month
A prospective study describes vortex keratopathy and corneal nerve loss with HER2-targeted ADCs; half of endothelial grafts fail by three years after a tube shunt; a 17-million-procedure registry sets endophthalmitis rates by operation; glaucoma suspect follow-up can be risk-stratified; and Diwali firecracker injuries remain mostly in children.
The edition in brief
In a prospective study of 21 patients with HER2-positive breast cancer on HER2-targeted antibody-drug conjugates, 18 (85.7%) developed ocular surface toxicity at a mean of 28 days, progressing from inferior microcysts to vortex keratopathy, with subepithelial nerve loss and reduced sensitivity; changes were dose- and time-dependent and partly reversible. A meta-analysis of 22 retrospective studies (943 grafts) found 36-month endothelial keratoplasty survival of 57% after prior glaucoma surgery and 50% after a glaucoma drainage device, with 63% endothelial cell loss at 12 months in drainage device eyes. The IRIS Registry analysis of 17.5 million procedures (2016–2024) put endophthalmitis at about 1 in 106 after adult open-globe repair, 1 in 2,652 after cataract surgery and similar after standalone MIGS, and higher after paediatric than adult cataract surgery. In 83,305 US glaucoma suspects, conversion to glaucoma ran at 9.4% in the first year and 5.3% a year thereafter, from 2.0% a year in untreated patients under 50 to 16.7% in treated patients over 70. A three-centre Indian study of 67 Diwali firecracker eye injuries found 62.7% were children, a third bystanders, and over 40% presented worse than 6/60.
Only half of endothelial grafts survive three years after a glaucoma drainage device
Counsel patients with a glaucoma drainage device that an endothelial graft has about a 50% chance of surviving three years.
Endophthalmitis rates by procedure from 17.5 million operations
Quote procedure-specific endophthalmitis risk at consent — about 1 in 2,650 for adult cataract surgery and 1 in 106 after open-globe repair.
Glaucoma suspects converted at about 5% a year after the first year
Set glaucoma suspect follow-up by risk: closer for older and treated patients, longer for young untreated suspects with stable tests.
Diwali firecracker eye injuries: mostly children, a third bystanders
Plan emergency eye cover for Diwali, and advise families that children and bystanders account for most firecracker eye injuries.
Shield, don't press, after a firecracker injury
After a firecracker eye injury, shield without pressure, irrigate contamination and refer urgently if the globe may be open.
Examine the ocular surface before and during HER2 antibody-drug conjugate therapy
Examine the ocular surface at baseline and within a month of starting a HER2-targeted antibody-drug conjugate, and manage toxicity with the oncology team.
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