Ocular Toxicity in GD-2 Antibody Therapy: A Case Study.

Abstract

Background: Ocular toxicities in children with neuroblastoma receiving GD-2 antibody therapy such as dinutuximab are uncommon. The objectives of this case study are to highlight the presentation and treatment of two ocular toxicities: pupillary palsy affecting visual acuity and photophobia, along with emphasizing the role of care providers in recognition and reporting of ocular adverse effects. Method: A 6-year-old boy with high-risk neuroblastoma presented to the outpatient clinic 4 days after completion of dinutuximab therapy stating that he was "going blind" and "the light hurt his eyes." He was treated with 1% pilocarpine drops and sunglasses for comfort after evaluation by ophthalmology. Results: The boy was diagnosed with bilateral mydriasis. The use of pilocarpine reportedly made him less photosensitive and provided some improvement to his pupillary palsy. His visual acuity did not appear to return to baseline; however, baseline examination was never performed. Further treatment with dinutuximab was not modified nor withheld, as providers were unable to fully determine degree of toxicity without baseline screening, and risk of dose modification or deletion was greater than current ocular toxicity. Discussion: Measuring a change in visual acuity and pupillary response is impossible without a baseline screening before commencing GD-2 antibody therapy. Although there is significant literature and reports on the identification and management of common side effects of GD-2 antibody therapy, less common ocular toxicities are possibly underreported with little guidance on management, thus making recognition and subsequent treatment challenging for nurses and providers.