Erdafitinib-associated retinal alterations and rapid onset bilateral white cataracts

This report aims to highlight the wide spectrum of ophthalmic adverse events associated with erdafitinib, a fibroblast growth factor inhibitor that blocks activation of the mitogen-activated protein kinase kinase (MAPK/MEK) cascade. The purpose of this report is to describe a case of erdafitinib-associated bilateral outer retinal alterations in the MEK-associated retinopathy spectrum and rapid onset bilateral total cataracts following a 20-month course of erdafitinib therapy.

A 69 year old male with metastatic bladder cancer presented 47 days following treatment initiation with daily erdafitinib (8-mg) with mild new subretinal fluid and minimal associated subretinal debris in the left eye and accentuation/thickening of the interdigitation zone in the right eye. Over the course of treatment, improvements were noted, particularly with erdafitinib dose reduction. At 20 months, both eyes developed rapidly progressive mature cataracts with significant visual changes, necessitating bilateral cataract extraction.

The potential stability of moderate outer retinal changes (i.e., ellipsoid zone/interdigitation zone, subretinal fluid) while continuing erdafitinib therapy is highlighted in this report. In addition, the importance of continued ophthalmic surveillance is emphasized given the possible association of anterior segment adverse events with long-term erdafitinib use.