Metastatic renal cell carcinoma: the first report of unilateral fundus hemorrhage induced by sorafenib
PURPOSE The aim of the article is to report a case of a patient with disseminated metastatic renal cell carcinoma on long-term treatment with sorafenib who had developed bilateral central retinal vein occlusion over a period of 6 months. METHODS A 73-year-old man with decreased visual acuity in the right eye and central retinal vein occlusion in the left eye 6 months previously. The patient had been on long-term treatment with the antiangiogenic drug, sorafenib for disseminated metastatic renal cell carcinoma-a highly vascularized tumor. The physical examination and fluorescein angiography showed a thrombus in the central retinal vein in the right eye and evidence of a past thrombus in the central retinal vein in the left eye. Numerous avascular zones in the retinas of both eyes were seen on angiography. The patient was prescribed anticoagulant medication and laser photocoagulation of the retina in both eyes and transscleral cryoapplication in the right retina were performed. RESULTS The treatment resulted in stabilizing the visual acuity (best-corrected visual acuity of the right eye was 0.01, best-corrected visual acuity of the left eye was 0.06) and decreasing the number and extent of avascular zones in the retinas of both eyes. No reduction of the chronic macular edema was achieved in the right eye. CONCLUSION The patient with disseminated metastatic renal cell carcinoma on long-term sorafenib treatment should undergo periodic ophthalmologic examinations to exclude any potential vascular complications associated with cancer (vein occlusion associated with disseminated metastatic disease, tumor embolus, tumor thrombus) or with treatment (antiangiogenic drugs, steroids).