厄洛替尼在眼表的并发症:3个病例不同转归  

Side effects on ocular surface after erlotinib treatment: different outcomes in 3 cases

作　　者：李梦玮 项俊 张朝然 LI Mengwei;XIANG Jun;ZHANG Chaoran(Department of Ophthalmology,Eye&ENT Hospital,Fudan University,Shanghai 200031,China)

机构地区：[1]复旦大学附属眼耳鼻喉科医院眼科,上海200031

出　　处：《中国眼耳鼻喉科杂志》2023年第1期86-89,共4页Chinese Journal of Ophthalmology and Otorhinolaryngology

摘　　要：目的 报道3例表皮生长因子受体抑制剂厄洛替尼眼表并发症患者的临床资料,并分析3个病例不同转归的原因。方法 病例系列报道。结果 病例1患者口服厄洛替尼近7年,眼部检查发现双眼角膜点状上皮脱落,未停用靶向药物而仅眼部用药后角膜上皮修复。病例2患者使用厄洛替尼2年余,单眼出现无菌性角膜溃疡伴角膜基质变薄,患眼接受多层羊膜移植同时停用厄洛替尼1周后,缺损的角膜上皮逐渐愈合。这2例患者全身除肺癌病史外,均无高血压、糖尿病及自身免疫性疾病等病史。病例3患者除了肺癌,还有明确的干燥综合征病史,在接受厄洛替尼治疗2年余后,眼表出现严重并发症,包括持续性角膜上皮缺损、角膜溶解和穿孔,并且进行了4次穿透性角膜移植术。停用厄洛替尼后眼表才逐渐趋于稳定。结论 在使用表皮生长因子受体抑制剂之前,需进行详细的眼部检查,排除眼表基础疾病,尤其是自身免疫性眼表疾病。同时,患者在使用此类药物期间需定期接受眼科随访,以避免眼表严重并发症的出现。Objective To report three cases of side effects on ocular surface after receiving erlotinib,a kind of epidermal growth factor receptor(EGFR) inhibitor, and to analyze the reasons of different outcomes in these three cases. Methods Case series report. Results The patient in case 1 has been treated with erlotinib orally for nearly seven years. Ocular examination showed punctate epithelial defects on both eyes. Corneal epithelium recovered after eye drops treatment without discontinuation of erlotinib. The patient in case 2 has been treated with erlotinib for over two years. Sterile corneal ulcer with thinning of corneal stroma was present on one eye. After the patient underwent multilayer amniotic membrane transplantations and discontinued erlotinib for one week, the corneal epithelium gradually healed. In these two cases, besides lung cancer, there was no past medical history of hypertension, diabetes or other autoimmune diseases. However, in case 3, the patient had Sj?gren syndrome besides lung cancer. After she was treated with erlotinib for over two years, severe ocular surface complications including persistent epithelial defect, corneal melting and perforation were not avoided and a total of four penetrating keratoplasties have been performed. Stable corneal surface was achieved after the erlotinib treatment was paused. Conclusions It is necessary to have detailed eye examinations before EGFR inhibitors treatment in order to exclude underlying ocular surface diseases, especially autoimmune ocular surface diseases. Meanwhile, regular ophthalmic follow-up should be performed during the use of these drugs to avoid severe side effects on ocular surface.

关 键 词：表皮生长因子受体抑制剂 厄洛替尼 眼表 持续性上皮缺损 角膜穿孔 

分 类 号：R771[医药卫生—眼科]